Project Description
Using the Electronic Health Record to Identify and Promote Goals-of-Care Communication
Goals-of-care
communication represents one of the most important aspects of palliative care,
yet remains a major shortcoming in our current healthcare system. Electronic
health records (EHR) provide a key opportunity to identify many patients who
would benefit from goals-of-care discussions.
This proposed
pilot study builds on two of our most successful programs. First, we will use
our quality improvement work with the EHR to identify our population of
interest: hospitalized patients with serious illness (encompassing multiple
acute and chronic illnesses) who do not have EHR documentation of a
goals-of-care discussion. Second, we will evaluate our Jumpstart intervention,
recently shown effective in the outpatient setting, that provides
patient-specific information to clinicians, patients, and family members to
prompt and guide goals-of-care discussions.
This study will
accomplish 3 aims. First, conduct a pilot randomized trial to evaluate
feasibility and acceptability of using the EHR to identify eligible
hospitalized patients and implement the intervention with hospitalized patients.
We will randomize patients to intervention (n=75) or usual care (n=75). Second,
we will evaluate the efficacy of the intervention for changing processes of
care with the primary outcome of EHR documentation of a goals-of-care
discussion. We will also assess other outcomes to ensure feasibility of outcome
assessment. Third, we will conduct semi-structured interviews with 30 trial
participants from the intervention group (10 patients, 10 family members,10
clinicians) to identify barriers and facilitators to implementation of the
intervention in a future trial and into clinical practice.
Although this
proposal is built on two successful prior programs (one research and one
quality improvement), the integration of their respective strategies produces
an innovative approach to implementing a novel intervention within a targeted
population of high need identified via automated EHR methods. Our findings will
provide pilot data for development of an innovative hybrid
effectiveness/implementation trial as the next step.
Bio
J. Randall Curtis, MD, MPH, completed medical school at Johns Hopkins University and internal medicine
residency as well as pulmonary and critical care fellowship training at the
University of Washington. He also
completed a two-year Robert Wood Johnson Faculty Scholar Program focused on
palliative care research. He is currently a pulmonary and critical care
physician and palliative medicine physician at Harborview Medical Center at the
University of Washington. He also holds
the A. Bruce Montgomery – American Lung Association Endowed Chair in Pulmonary
and Critical Care Medicine and he is the inaugural Director of the Cambia
Palliative Care Center of Excellence at the University of Washington. He has an active research program with over
15 years of funding from the National Institutes of Health and has also
received funding from a number of foundations including the Cambia Health
Foundation, Robert Wood Johnson Foundation, the Soros Open Society Institute, and
the Greenwall Foundation. His research focuses
on improving palliative care for patients with critical illness and patients
with chronic and life-limiting illnesses as well as patients’ families. He has authored more than 250 peer-reviewed
research articles and more than 150 editorials and chapters. He is also
committed to mentoring in palliative care research and is the director of two
T32 awards and a K12 award from the National Institutes of Health to train
researchers of the future. Dr. Curtis
has been the recipient of several awards for his research and teaching in
palliative and end-of-life care including the Sojourns Award from the Cambia
Health Foundation, the Roger C. Bone Award for Advances End-of-life Care from
the American College of Chest Physicians, the Grenvik Family Award for Ethics
from the Society of Critical Care Medicine, and the American Academy of Hospice and Palliative Medicine Award for Excellence
in Scientific Research in Palliative Care. In 2017, he was named one of the 30 Visionaries
in Hospice and Palliative Medicine by the American Academy of Hospice and
Palliative Medicine.
Email: jrc@uw.edu