Primary Palliative Care for Emergency Medicine (PRIM-ER)

NYU Langone Health

Status: Active, not recruiting

Conditions: Emergencies

Treatments: Behavioral: healthcare service utilization in the six months following the ED visit

Study type: Observational

Funder types: Other; NIH

Identifiers

NCT03424109

5UH3AT009844 (U.S. NIH Grant/Contract)

18-00607

Details and patient eligibility

About

This proposal builds upon the evaluation of Primary Palliative Care Education, Training, and Technical Support for Emergency Medicine (PRIM-ER) implemented in 33 Emergency Departments (EDs). This is a retrospective cohort study that seeks to measure the effect of PRIM-ER on older adults with serious illness on aspects of: 1) ED disposition to an acute setting; 2) healthcare utilization in the 6 months following the index ED visit; 3) survival following the index ED visit; and 4) determine site, provider, and patient-level characteristics that are associated with variation in impact of PRIM-ER across sites.

Enrollment: 57,717 estimated patients

Sex: All

Ages: 66+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients must demonstrate one-year mortality of at least 30 percent (score > 6) according to the Gagne Index, a validated instrument used to measure all cause one-year mortality in community-dwelling older adults, calculated based on their prior 12 months before the index ED visit of Medicare claims.

Exclusion criteria

• ED patients transferred from a nursing home on the index ED visit will be excluded since prediction of mortality and disposition of such patients differs from community-dwelling adults.
• Patients currently receiving hospice at the time of the index ED visit will also be excluded since they have already received services.

Trial design

57,717 participants in 1 patient group

Beneficiaries with a one-year mortality of at least 30%

Description:

The patient cohort will be extracted via the Centers for Medicare and Medicaid Services (CMS) Research Data Assistance Center (ResDAC) using a two-step process to maximize diversity, and minimize intentional or unintentional exclusions based on risk, age, health literacy, demographics, or expected adherence.

Treatment:

Behavioral: healthcare service utilization in the six months following the ED visit