Primary Palliative Care for Emergency Medicine (PRIM-ER): Protocol for a Pragmatic, Cluster-Randomised, Stepped Wedge Design to Test the Effectiveness of Primary Palliative Care Education, Training and Technical Support for Emergency Medicine. Issue 7 (27th July 2019)

• Record Type: Journal Article
• Authors: Grudzen, Corita R; Brody, Abraham A; Chung, Frank R; Cuthel, Allison M; Mann, Devin; McQuilkin, Jordan A; Rubin, Ada L; Swartz, Jordan; Tan, Audrey; Goldfeld, Keith S
• Other Names: author non-byline.; Abella Bejamin author non-byline.; Abraham Gallane author non-byline.; Cridge Terri Arlitsch author non-byline.; Asselta Robert author non-byline.; Ballaraon Brittany author non-byline.; Bastani Aveh author non-byline.; Bastien Danielle author non-byline.; Black Andrew author non-byline.; Bledsoe Shannon author non-byline.; Bolden Deidre author non-byline.; Bolden David author non-byline.; Bollman Tracy author non-byline.; Bonato Abby author non-byline.; Elie Marie-Carmelle author non-byline.; Caterino Jeffrey author non-byline.; Chiu Laraine author non-byline.; Chodosh Joshua author non-byline.; Christenson Molly author non-byline.; Cooper Julie author non-byline.; Deutsch Ashley author non-byline.; Elsayem Ahmed author non-byline.; Ergorova Natasha author non-byline.; Evelyn Karen author non-byline.; Bellolio M Fernanda author non-byline.; Feronti Charles author non-byline.; Fleischer-Black Jessica author non-byline.; Frontera Natalie author non-byline.; Fuller Tim author non-byline.; Gafford Ellin author non-byline.; Gamboa Michelle author non-byline.; Gang Maureen author non-byline.; Garduno Shelby author non-byline.; Gartner Michael author non-byline.; Goett Rebecca author non-byline.; Grange Emily author non-byline.; Grudzen Corita author non-byline.; Guerry Roshni author non-byline.; Harris Jennifer author non-byline.; Cohen Daniel Herbert author non-byline.; Hirtz Christopher author non-byline.; Hochman Judith author non-byline.; Horwitz Leora author non-byline.; Isaacs Eric author non-byline.; Johnson Mindi author non-byline.; Johnson Deb author non-byline.; Jubanyik Karen author non-byline.; Kim Anne author non-byline.; Knight Gail author non-byline.; Kulacz Regina author non-byline.; Lamba Sangeeta author non-byline.; Lin Michelle author non-byline.; Linsata Heather author non-byline.; Liroff Meghan author non-byline.; Long Elizabeth author non-byline.; Loprinzi-Brauer Caitlin author non-byline.; Navarro Anne author non-byline.; Madsen Troy author non-byline.; Mclay Kaysea author non-byline.; Miller Joseph author non-byline.; Morello Catharin author non-byline.; O'Neill John author non-byline.; Otero Ronny author non-byline.; Ouchi Kei author non-byline.; Richardson Lynne author non-byline.; Richardson Christopher author non-byline.; Rowe Todd author non-byline.; Schoenfeld Elizabeth author non-byline.; Shaw Melissa author non-byline.; Shelley Donna author non-byline.; Shreves Ashley author non-byline.; Siller Jennifer author non-byline.; Singer Elizabeth author non-byline.; Southerland Lauren author non-byline.; Steucher Laura author non-byline.; Swor Robert author non-byline.; Szabo Kelly author non-byline.; Torre Andrea author non-byline.; Toulson Karen author non-byline.; Troxel Andrea author non-byline.; Urosek Rachel author non-byline.; Uspal Julie author non-byline.; Varghese Tiny author non-byline.; Venkat Arvind author non-byline.; Wood Travis author non-byline.; Zimny Erin author non-byline.;
• Is Part Of: BMJ open. Volume 9:Issue 7(2019)
• Publication Date: 2019-07-27
• Subjects: adult palliative care -- health informatics; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2019-030099
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Introduction: Emergency departments (ED) care for society's most vulnerable older adults who present with exacerbations of chronic disease at the end of life, yet the clinical paradigm focuses on treatment of acute pathologies. Palliative care interventions in the ED capture high-risk patients at a time of crisis and can dramatically improve patient-centred outcomes. This study aims to implement and evaluate Primary Palliative Care for Emergency Medicine (PRIM-ER) on ED disposition, healthcare utilisation and survival in older adults with serious illness. Methods and analysis: This is the protocol for a pragmatic, cluster-randomised stepped wedge trial to test the effectiveness of PRIM-ER in 35 EDs across the USA. The intervention includes four core components: (1) evidence-based, multidisciplinary primary palliative care education; (2) simulation-based workshops; (3) clinical decision support; and (4) audit and feedback. The study is divided into two phases: a pilot phase, to ensure feasibility in two sites, and an implementation and evaluation phase, where we implement the intervention and test the effectiveness in 33 EDs over 2 years. Using Centers for Medicare and Medicaid Services (CMS) data, we will assess the primary outcomes in approximately 300 000 patients: ED disposition to an acute care setting, healthcare utilisation in the 6 months following the ED visit and survival following the index ED visit. Analysis will also determine the site, provider and patient-level characteristics that are associated with variation in impact of PRIM-ER. Ethics and dissemination: Institutional Review Board approval was obtained at New York University School of Medicine to evaluate the CMS data. Oversight will also be provided by the National Institutes of Health, an Independent Monitoring Committee and a Clinical Informatics Advisory Board. Trial results will be submitted for publication in a peer-reviewed journal. Trial registration number: NCT03424109 ; Pre-results