A Stepped-Wedge Randomized-Controlled Trial Assessing the Implementation, Impact and Costs of a Prospective Feedback Loop to Promote Appropriate Care and Treatment for Older Patients in Acute Hospitals at the End of Life: Study Protocol

In: BMC Geriatrics, Vol. 20, No. 1, 29.07.2020, p. 262.

9 Pages Posted: 21 Sep 2020

See all articles by Xing Ju Lee

Xing Ju Lee

Queensland University of Technology - Institute of Health and Biomedical Innovation

Hannah Carter

Queensland University of Technology

Nicholas Graves

Queensland University of Technology

Gill Harvey

University of Adelaide

Ben White

Queensland University of Technology - Faculty of Law

Lindy Willmott

Queensland University of Technology - Faculty of Law

Magnolia Cardona

Bond University - Institute for Evidence-Based Healthcare

Leonie Callaway

University of Queensland

Adrian Barnett

Queensland University of Technology; Prince Charles Hospital

Date Written: 2020

Abstract

BACKGROUND: Hospitalization rates for the older population have been increasing with end-of-life care becoming a more medicalized and costly experience. There is evidence that some of these patients received non-beneficial treatment during their final hospitalization with a third of the non-beneficial treatment duration spent in intensive care units. This study aims to increase appropriate care and treatment decisions and pathways for older patients at the end of life in Australia. This study will implement and evaluate a prospective feedback loop and tailored clinical response intervention at three hospitals in Queensland, Australia.

METHODS: A stepped-wedge cluster randomized trial will be conducted with up to 21 clinical teams in three acute hospitals over 70 weeks. The study involves clinical teams providing care to patients aged 75 years or older, who are prospectively identified to be at risk of non-beneficial treatment using two validated tools for detecting death and deterioration risks. The intervention's feedback loop will provide the teams with a summary of these patients' risk profiles as a stimulus for a tailored clinical response in the intervention phase. The Consolidated Framework for Implementation Research will be used to inform the intervention's implementation and process evaluation. The study will determine the impact of the intervention on patient outcomes related to appropriate care and treatment at the end of life in hospitals, as well as the associated healthcare resource use and costs. The primary outcome is the proportion of patients who are admitted to intensive care units. A process evaluation will be carried out to assess the implementation, mechanisms of impact, and contextual barriers and enablers of the intervention.

DISCUSSION: This intervention is expected to have a positive impact on the care of older patients near the end of life, specifically to improve clinical decision-making about treatment pathways and what constitutes appropriate care for these patients. These will reduce the incidence of non-beneficial treatment, and improve the efficiency of hospital resources and quality of care. The process evaluation results will be useful to inform subsequent intervention implementation at other hospitals.

TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry (ANZCTR), ACTRN12619000675123p (approved 6 May 2019).

Keywords: end-of-life care, geriatrics, high-risk, older population, risk assessment, intensive care, medical futility, non-beneficial treatment, prospective feedback loop intervention, stepped-wedge cluster randomized trial

JEL Classification: I1, I18, I12, I19

Suggested Citation

Lee, Xing Ju and Carter, Hannah and Graves, Nicholas and Harvey, Gill and White, Ben and Willmott, Lindy and Cardona, Magnolia and Callaway, Leonie and Barnett, Adrian, A Stepped-Wedge Randomized-Controlled Trial Assessing the Implementation, Impact and Costs of a Prospective Feedback Loop to Promote Appropriate Care and Treatment for Older Patients in Acute Hospitals at the End of Life: Study Protocol (2020). In: BMC Geriatrics, Vol. 20, No. 1, 29.07.2020, p. 262., Available at SSRN: https://ssrn.com/abstract=3668603

Xing Ju Lee

Queensland University of Technology - Institute of Health and Biomedical Innovation ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Hannah Carter

Queensland University of Technology ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Nicholas Graves

Queensland University of Technology ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Gill Harvey

University of Adelaide ( email )

No 233 North Terrace, School of Commerce
Adelaide, South Australia 5005
Australia

Ben White (Contact Author)

Queensland University of Technology - Faculty of Law ( email )

Level 4, C Block Gardens Point
2 George St
Brisbane, QLD 4000
Australia

HOME PAGE: http://staff.qut.edu.au/staff/whiteb/

Lindy Willmott

Queensland University of Technology - Faculty of Law ( email )

Level 4, C Block Gardens Point
2 George St
Brisbane, QLD 4000
Australia

HOME PAGE: http://staff.qut.edu.au/staff/willmott/

Magnolia Cardona

Bond University - Institute for Evidence-Based Healthcare

14 University Dr
Robina, QLD 4226
Australia

Leonie Callaway

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Adrian Barnett

Queensland University of Technology ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Prince Charles Hospital ( email )

Australia

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