Improving Communication for Primary Care Patients
Study Details
Study Description
Brief Summary
This is a pragmatic trial of SHARING Choices. Components of SHARING Choices include:
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A letter from the clinic introducing an initiative to prepare persons and families for Advance Care Planning (ACP);
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Access to a facilitator trained to lead ACP discussions;
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Patient-family agenda-setting to align perspectives about the role of family and stimulate discussion about ACP;
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Facilitated registration to the patient portal (for patient and family) as desired;
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Education & resources about Alzheimer's Disease and Related Dementias (ADRD) for clinic staff.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
N/A |
Detailed Description
Engaging family in primary care is particularly important in Alzheimer's Disease and Related Dementias (ADRD) because of the important role assumed in medical decision-making, especially at the end of life. The investigators, study seeks to improve communication in primary care through methods to proactively engage family in ongoing interactions with primary care and stimulate and support Advance Care Planning (ACP) for all older adults and attention to ADRD in primary care throughout the ADRD disease trajectory. The investigators' premise is that individuals and families appreciate primary care involvement in ACP and information and referrals for ADRD needs, but that individual, family, and system factors including time, knowledge, and resources often inhibit these conversations from occurring.
SHARING Choices integrates communication strategies that have been individually found to be effective but have thus far been deployed in isolation of one another. The investigators focus on all older primary care patients because of the importance of addressing ACP early, the under-diagnosis of ADRD and the greater implementation potential of a protocol with broad applicability.
Components of SHARING Choices include:
-
A letter from the clinic introducing an initiative to prepare persons and families for Advance Care Planning (ACP);
-
Access to a facilitator trained to lead ACP discussions;
-
Patient-family agenda-setting to align perspectives about the role of family and stimulate discussion about ACP;
-
Facilitated registration to the patient portal (for patient and family) as desired;
-
Education & resources about ADRD for clinic staff.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: SHARING Choices Components of SHARING Choices include: A letter from the clinic introducing an initiative to prepare persons and families for Advance Care Planning (ACP); Access to a facilitator trained to lead ACP discussions; Patient-family agenda-setting to align perspectives about the role of family and stimulate discussion about ACP; Facilitated registration to the patient portal (for patient and family) as desired; Education & resources about Alzheimer's Disease and Related Dementias (ADRD) for clinic staff. |
Behavioral: SHARING Choices
SHARING Choices is a multicomponent communication intervention to proactively engage family members or friends and to support advance care planning in primary care
|
No Intervention: Usual care Usual care |
Outcome Measures
Primary Outcome Measures
- Proportion of patients 65 and older with documentation of any advance directive in the Electronic Health Record (EHR) [1 year]
Advance directive will be defined as a durable power of attorney, living will, Maryland Medical Order for Life Sustaining Treatment (MOLST), or District of Columbia Medical Order for Sustaining Treatment (MOST) based on information that is recorded in each care delivery system's electronic medical record 12 months after study entry. The initial visit date for each candidate patient after the inception of the trial serves as the beginning of the 12-month observation period and will be used to construct comparable observation periods for candidate patients at both intervention and control groups.
Secondary Outcome Measures
- Occurrence of potentially burdensome procedures reported within 6 months preceding death [6 months preceding patient death]
Potentially burdensome care will be measured as any (yes/no) procedures within the 6 months that precede death using dates and validated International Classification of Diseases (ICD)-10 codes for hospital services that will be extracted from CRISP, the regional health information exchange, which includes a repository of all hospital encounters in Maryland, Delaware, West Virginia, and the District of Columbia. Specific procedures and codes that will be used to reflect burdensome care include intubation and mechanical ventilation, tracheostomy, gastrostomy feeding tube placement, hemodialysis, enteral and parenteral nutrition, and cardiopulmonary resuscitation. We limit our analysis of this measure to patients with diagnosis codes indicative of serious illness, for whom these procedures would be considered potentially burdensome, drawing from a list of ICD-10 codes.
Eligibility Criteria
Criteria
Inclusion Criteria:
Practices included in this trial are:
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Affiliated with Johns Hopkins Community Physicians (JHCP) or MedStar Health;
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A primary care practice, defined as adult internal medicine, family medicine, or geriatric medicine;
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Have 2 or more practicing clinicians; and
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Have more than 500 patients aged 65 and over currently receiving care.
Patients included in this trial are:
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Age 65 and older, and
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Established patient of primary care clinician at participating practice (>1 prior visit at the clinic). There will be no formal enrollment of participants into this pragmatic trial as this is a clinic-level initiative that will be available and offered to all eligible patients at clinics randomized to the intervention.
Exclusion criteria:
Primary care practices affiliated with Johns Hopkins Community Physicians (JHCP) or MedStar
Health that are:
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Not a primary care practice, defined as adult internal medicine, family medicine, or geriatric medicine;
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Have fewer than 2 practicing clinicians; and
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Have fewer than 500 patients aged 65 and over currently receiving care.
Patients under the care of primary care practices affiliated with Johns Hopkins Community
Physicians (JHCP) or MedStar Health that are:
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Less than 65 years of age, or
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Not established patients.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Johns Hopkins Community Physicians - I Street | Washington | District of Columbia | United States | 20005 |
2 | MedStar Georgetown University Hospital General Internal Medicine | Washington | District of Columbia | United States | 20007 |
3 | MedStar Medical Group at MedStar Washington Hospital Center | Washington | District of Columbia | United States | 20010 |
4 | MedStar Washington Hospital Center Physician Group LLC | Washington | District of Columbia | United States | 20010 |
5 | MedStar Medical Group at New Mexico Avenue | Washington | District of Columbia | United States | 20016 |
6 | MedStar Medical Group at Lafayette Centre | Washington | District of Columbia | United States | 20036 |
7 | MedStar Greater Annapolis Medical Group | Annapolis | Maryland | United States | 21401 |
8 | Johns Hopkins Community Physicians - Remington | Baltimore | Maryland | United States | 21211 |
9 | MedStar Union Memorial Adult Medicine Specialists at 33rd St. | Baltimore | Maryland | United States | 21218 |
10 | Johns Hopkins Bayview Medical Center | Baltimore | Maryland | United States | 21224 |
11 | Johns Hopkins Community Physicians - Canton Crossing | Baltimore | Maryland | United States | 21224 |
12 | MedStar Medical Group at Wilkens Center | Baltimore | Maryland | United States | 21229 |
13 | MedStar Health at Federal Hill | Baltimore | Maryland | United States | 21230 |
14 | MedStar Medical Group at North Parkville Health Center | Baltimore | Maryland | United States | 21234 |
15 | Family Health Center at MedStar Franklin Square Medical Center | Baltimore | Maryland | United States | 21237 |
16 | MedStar Medical Group at Ridge Road | Baltimore | Maryland | United States | 21237 |
17 | The Primary Care Center at MedStar Franklin Square Medical Center | Baltimore | Maryland | United States | 21237 |
18 | MedStar Good Samaritan Hospital Medical Faculty Practice | Baltimore | Maryland | United States | 21239 |
19 | The Center for Successful Aging at MedStar Good Samaritan Hospital | Baltimore | Maryland | United States | 21239 |
20 | MedStar Medical Group at Old Emmorton Rd | Bel Air | Maryland | United States | 21015 |
21 | Johns Hopkins Community Physicians - Water's Edge | Belcamp | Maryland | United States | 21017 |
22 | Johns Hopkins Community Physicians - Downtown Bethesda | Bethesda | Maryland | United States | 20814 |
23 | MedStar Medical Group at Bethesda | Bethesda | Maryland | United States | 20815 |
24 | Johns Hopkins Community Physicians - Bowie | Bowie | Maryland | United States | 20715 |
25 | MedStar Medical Group at MedStar Health at Brandywine | Brandywine | Maryland | United States | 20613 |
26 | MedStar Medical Group Primary Care at Clinton | Clinton | Maryland | United States | 20735 |
27 | Johns Hopkins Community Physicians - Howard County | Columbia | Maryland | United States | 21046 |
28 | MedStar Medical Group at Dundalk Professional Center | Dundalk | Maryland | United States | 21222 |
29 | Johns Hopkins Community Physicians - Annapolis | Edgewater | Maryland | United States | 21037 |
30 | MedStar Medical Group at Dorsey Hall | Ellicott City | Maryland | United States | 21042 |
31 | MedStar Medical Group at Forest Hill | Forest Hill | Maryland | United States | 21050 |
32 | MedStar Medical Group Primary Care at Fort Washington | Fort Washington | Maryland | United States | 20744 |
33 | Johns Hopkins Community Physicians - Frederick | Frederick | Maryland | United States | 21702 |
34 | Johns Hopkins Community Physicians - Fulton | Fulton | Maryland | United States | 20759 |
35 | Johns Hopkins Community Physicians - Germantown | Germantown | Maryland | United States | 20876 |
36 | Johns Hopkins Community Physicians - Glen Burnie | Glen Burnie | Maryland | United States | 21061 |
37 | Johns Hopkins Community Physicians - Hagerstown | Hagerstown | Maryland | United States | 21742 |
38 | MedStar Medical Group at Hyattsville | Hyattsville | Maryland | United States | 20782 |
39 | MedStar Medical Group at Laurel | Laurel | Maryland | United States | 20707 |
40 | MedStar Medical Group at St. Clement's | Leonardtown | Maryland | United States | 20650 |
41 | MedStar Medical Group at St. Mary's | Leonardtown | Maryland | United States | 20650 |
42 | Johns Hopkins Health Care & Surgery Center - Green Spring Station | Lutherville | Maryland | United States | 21093 |
43 | MedStar Medical Group at Mitchellville | Mitchellville | Maryland | United States | 20721 |
44 | Johns Hopkins Community Physicians - Odenton | Odenton | Maryland | United States | 21113 |
45 | MedStar Medical Group 18111 Prince Philip | Olney | Maryland | United States | 20832 |
46 | MedStar Medical Group at Olney Professional Park | Olney | Maryland | United States | 20832 |
47 | MedStar Medical Group Family Practice at Olney | Olney | Maryland | United States | 20832 |
48 | MedStar Medical Group at Honeygo Center | Perry Hall | Maryland | United States | 21128 |
49 | Johns Hopkins Community Physicians - Rockville (Montgomery Grove) | Rockville | Maryland | United States | 20850 |
50 | Johns Hopkins Community Physicians - North Bethesda | Rockville | Maryland | United States | 20852 |
51 | MedStar Medical Group at Silver Spring | Silver Spring | Maryland | United States | 20902 |
52 | Johns Hopkins Community Physicians - Westminster | Westminster | Maryland | United States | 21157 |
53 | Johns Hopkins Community Physicians - Charles County | White Plains | Maryland | United States | 20695 |
54 | MedStar Medical Group at Alexandria | Alexandria | Virginia | United States | 22302 |
Sponsors and Collaborators
- Johns Hopkins University
- Medstar Health Research Institute
Investigators
- Principal Investigator: Jennifer Wolff, PhD, Johns Hopkins University
Study Documents (Full-Text)
None provided.More Information
Publications
- Barnato AE, Farrell MH, Chang CC, Lave JR, Roberts MS, Angus DC. Development and validation of hospital "end-of-life" treatment intensity measures. Med Care. 2009 Oct;47(10):1098-105. doi: 10.1097/MLR.0b013e3181993191.
- Briggs LA, Kirchhoff KT, Hammes BJ, Song MK, Colvin ER. Patient-centered advance care planning in special patient populations: a pilot study. J Prof Nurs. 2004 Jan-Feb;20(1):47-58.
- Hammes BJ, Rooney BL. Death and end-of-life planning in one midwestern community. Arch Intern Med. 1998 Feb 23;158(4):383-90.
- Pecanac KE, Repenshek MF, Tennenbaum D, Hammes BJ. Respecting Choices® and advance directives in a diverse community. J Palliat Med. 2014 Mar;17(3):282-7. doi: 10.1089/jpm.2013.0047. Epub 2013 Dec 10.
- Walling AM, Sudore RL, Bell D, Tseng CH, Ritchie C, Hays RD, Gibbs L, Rahimi M, Sanz J, Wenger NS. Population-Based Pragmatic Trial of Advance Care Planning in Primary Care in the University of California Health System. J Palliat Med. 2019 Sep;22(S1):72-81. doi: 10.1089/jpm.2019.0142.
- Wasp GT, Alam SS, Brooks GA, Khayal IS, Kapadia NS, Carmichael DQ, Austin AM, Barnato AE. End-of-life quality metrics among medicare decedents at minority-serving cancer centers: A retrospective study. Cancer Med. 2020 Mar;9(5):1911-1921. doi: 10.1002/cam4.2752. Epub 2020 Jan 11.
- Wolff JL, Roter DL, Boyd CM, Roth DL, Echavarria DM, Aufill J, Vick JB, Gitlin LN. Patient-Family Agenda Setting for Primary Care Patients with Cognitive Impairment: the SAME Page Trial. J Gen Intern Med. 2018 Sep;33(9):1478-1486. doi: 10.1007/s11606-018-4563-y. Epub 2018 Jul 18.
- IRB00224501