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Project to Improve Communication About Serious Illness--Hospital Study: Comparative Effectiveness Trial (Trial 2)

The objective of this protocol is to test the effectiveness of a Jumpstart intervention on patient-centered outcomes for patients with chronic illness by ensuring that they receive care that is concordant with their goals over time, and across settings and providers. This study is particularly interested in understanding the effect of the intervention to improve quality of palliative care for patients with Alzheimer's disease and related dementias (ADRD) but will also include other common chronic, life-limiting illnesses. The specific aims are: 1) To evaluate the effectiveness of a survey-based patient/clinician Jumpstart guide compared to an EHR-based clinician Jumpstart guide for improving quality of care; the primary outcome is documentation of a goals-of-care discussion during the hospitalization. Secondary outcomes include: intensity of care (ICU use, ICU and hospital length of stay, costs of care during the hospitalization, and 30-day hospital readmission); patient- and surrogate/family-reported outcomes assessed by survey at 1 and 3 months after randomization including occurrence and quality of goals-of-care communication in the hospital, goal concordant care, psychological symptoms, quality of life, and palliative care needs. 2) To conduct a mixed-methods evaluation of the implementation of the intervention, guided by the RE-AIM framework for implementation science, incorporating quantitative evaluation of the intervention's reach and adoption, as well as qualitative analyses of interviews with participants, to explore barriers and facilitators to future implementation and dissemination.

Start: July 2021