EFFICACY: Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning by Hospitalists
Study Details
Study Description
Brief Summary
Hopewell Hospitalist is a theory-based adventure video game designed to increase the likelihood that a physician will engage in an advance care planning (ACP) conversation with a patient over the age of 65. Drawing on the theory of narrative engagement, players assume the persona of a hospitalist and navigate a series of clinical encounters with seriously-ill patients over the age of 65. Players experience the consequences of having (or not having) ACP conversations in a timely fashion. The planned study is a pragmatic stepped-wedge crossover phase III trial testing the efficacy of Hopewell Hospitalist for increasing ACP rates measured by ACP billing frequency.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| No Intervention: Usual Care Control The control arm occurs prior to receipt of the video game intervention. Each hospital group 'crosses over' from control to intervention at a randomized time point. |
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| Experimental: Video Game Intervention Each hospital group 'crosses over' from control to intervention at a randomized time point by receiving a study iPad and playing the video game loaded on the iPad. |
Behavioral: Hopewell Hospitalist Video Game
Hopewell Hospitalist is a customized theory-based adventure video game that uses narrative engagement to educate physician players on advance care planning to increase physicians' likelihood of engaging in and billing for ACP conversations.
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Outcome Measures
Primary Outcome Measures
- Incidence of Billed Advance Care Planning [6 months (3 months pre and 3 months post intervention)]
Change in physician advance care planning billing for patients over the age of 65 in the three months before and after the roll-out of the video game intervention at their hospital. Advance care planning billing is defined as the presence/absence of ACP charges (Medicare billing codes 99497 or 99498) during a physician's patient's hospitalization.
- Merit-based Incentive Payment System Advance Care Planning Quality Score [6 months (3 months pre and 3 months post intervention)]
Change in the Merit-based Incentive Payment System (MIPS) self-report measure of advance care planning by enrolled hospitalists (MiPS-ACP quality score). The MiPS-ACP quality score is the percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. The quality score ranges from 0-100%, with higher scores indicating that a greater proportion of patients with an advance care plan documented in the medical record.
- Patient Chart Advance Care Planning Documentation [6 months (3 months pre and 3 months post intervention)]
Frequency measures of advance care planning documentation in physician notes in patient charts by enrolled hospitalists.
Secondary Outcome Measures
- Hospitalist-Managed Patient In-Hospital Mortality Rate [6 months (3 months pre and 3 months post intervention)]
In-hospital mortality rate for patients managed by enrolled hospitalists.
- Hospitalist-Managed Patient 90-Day Mortality Rate [6 months (3 months pre and 3 months post intervention)]
90-day mortality rate for patients managed by enrolled hospitalists.
- Sum of Resources Utilized by Hospitalist-Managed Patients [6 months (3 months pre and 3 months post intervention)]
Combined sum of resources utilized by patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). It is a composite measure including: admission to ICU, receipt of life-sustaining treatment(s) including mechanical ventilation, placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis. This measure ranges from 0 to 5, where higher scores indicate greater utilization of resources during the index hospitalization.
- Incidence of Hospitalist-Managed Patient Admission to ICU [6 months (3 months pre and 3 months post intervention)]
Incidence of admission to ICU for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
- Incidence of Hospitalist-Managed Patient Mechanical Ventilation [6 months (3 months pre and 3 months post intervention)]
Incidence of mechanical ventilation of patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
- Incidence of Hospitalist-Managed Patient Receipt of Life-Sustaining Treatment(s) [6 months (3 months pre and 3 months post intervention)]
Incidence of placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
- Hospitalist-Managed Patient Length of Stay [6 months (3 months pre and 3 months post intervention)]
Total days between admission and discharge for patients managed by enrolled hospitalists.
- Hospitalist-Managed Patient Disposition Status Type [6 months (3 months pre and 3 months post intervention)]
Type of status upon discharge of patients managed by enrolled hospitalists (e.g., discharged to home, to skilled nursing, to hospice, deceased, etc.).
- Hospitalist-Managed Patient 90-Day Episode-Based Spending [6 months (3 months pre and 3 months post intervention)]
Amount of total Medicare payments between index admission and 90-days for patients managed by enrolled hospitalists.
Other Outcome Measures
- Hospitalist Advance Care Planning Attitudes Vignette-Based Measure [1 month]
Responses to patient case vignettes by enrolled hospitalists' regarding patient priority for advance care planning conversation. For each vignette, enrolled hospitalists decide if and how a patient in a case vignette receives an advanced care planning conversation by selecting one of four responses categories: No, Primary Care Physician, Admit, or Now.
- Hospitalist Advance Care Planning Attitudes Questionnaire-Based Measure [1 month]
Individual and aggregated responses to 10-item questionnaire regarding enrolled hospitalists' attitudes towards advance care planning. Each of the ten items is a 5-point Likert scale. Higher scores indicate positive attitudes and lower scores indicate negative attitudes.
Eligibility Criteria
Criteria
Hospital Inclusion Criteria:
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Value-based delivery model of care (Bundled Payment Care Initiative)
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Staffed by Sound Physicians for at least 2 quarters
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Advance care planning billing rate in prior quarter greater than 0 percent
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Employs a nurse liaison
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Hospitalist chief approval to approach hospitalists
Hospital Exclusion Criteria:
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Sound Physicians no longer staffing the hospital
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Not staffed by Sound Physicians for at least 2 quarters
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Advance care planning billing rate in prior quarter of 0 percent
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Does not employ a nurse liaison
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Hospitalist chief disapproval to approach hospitalists
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Hospitalist chief does not provide contact information for hospitalists
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Target number of hospitalists for the "step" has been met or exceeded
Hospitalist Inclusion Criteria:
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Employed by Sound for at least 2 quarters and staffing an eligible hospital for at least 1 quarter
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ACP billing rate in prior quarter greater than 0 percent or answers eligibility question affirming use of ACP billing codes
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Provides informed consent
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Name matches a name in the contact list for the sample; OR is verified by communication through an employer-based email address
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Receipt of a functional iPad within study step time frame
Hospitalist Exclusion Criteria:
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Not employed by Sound for at least 2 quarters and staffing an eligible hospital for at least 1 quarter
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ACP billing rate in prior quarter of 0 percent or answers eligibility question refusing use of ACP billing
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Does not provide informed consent
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Provides consent after the given deadline for consenting
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Name does not match a name in the contact list for the sample; OR cannot be verified by communication through an employer-based email address
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Receipt of a nonfunctional iPad within study step time frame
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If the number of participants who consent per site exceeds targets, then participants who are part-time employees will be preferentially excluded
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Dartmouth Hitchcock Medical Center | Lebanon | New Hampshire | United States | 03766 |
Sponsors and Collaborators
- Dartmouth-Hitchcock Medical Center
- Sound Physicians
- National Institute on Aging (NIA)
Investigators
- Principal Investigator: Amber Barnato, MD, MPH, MS, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine�
Study Documents (Full-Text)
More Information
Publications
None provided.- STUDY00031186
- P01AG019783