BMJ Open (Jul 2019)

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

  • Corita R Grudzen,
  • Keith S Goldfeld,
  • Lauren Southerland,
  • Marie-Carmelle Elie,
  • Robert Swor,
  • Ellin Gafford,
  • Audrey Tan,
  • Anne Kim,
  • Andrea Troxel,
  • Karen Jubanyik,
  • Corita Grudzen,
  • Abraham A Brody,
  • Frank R Chung,
  • Allison M Cuthel,
  • Devin Mann,
  • Jordan A McQuilkin,
  • Ada L Rubin,
  • Jordan Swartz,
  • Bejamin Abella,
  • Gallane Abraham,
  • Terri Arlitsch Cridge,
  • Robert Asselta,
  • Brittany Ballaraon,
  • Aveh Bastani,
  • Danielle Bastien,
  • Andrew Black,
  • Shannon Bledsoe,
  • Deidre Bolden,
  • David Bolden,
  • Tracy Bollman,
  • Abby Bonato,
  • Jeffrey Caterino,
  • Laraine Chiu,
  • Joshua Chodosh,
  • Molly Christenson,
  • Julie Cooper,
  • Ashley Deutsch,
  • Ahmed Elsayem,
  • Natasha Ergorova,
  • Karen Evelyn,
  • M Fernanda Bellolio,
  • Charles Feronti,
  • Jessica Fleischer-Black,
  • Natalie Frontera,
  • Tim Fuller,
  • Michelle Gamboa,
  • Maureen Gang,
  • Shelby Garduno,
  • Michael Gartner,
  • Rebecca Goett,
  • Emily Grange,
  • Roshni Guerry,
  • Jennifer Harris,
  • Daniel Herbert Cohen,
  • Christopher Hirtz,
  • Judith Hochman,
  • Leora Horwitz,
  • Eric Isaacs,
  • Mindi Johnson,
  • Deb Johnson,
  • Gail Knight,
  • Regina Kulacz,
  • Sangeeta Lamba,
  • Michelle Lin,
  • Heather Linsata,
  • Meghan Liroff,
  • Elizabeth Long,
  • Caitlin Loprinzi-Brauer,
  • Anne Navarro,
  • Troy Madsen,
  • Kaysea Mclay,
  • Joseph Miller,
  • Catharin Morello,
  • John O’Neill,
  • Kei Ouchi,
  • Lynne Richardson,
  • Christopher Richardson,
  • Todd Rowe,
  • Elizabeth Schoenfeld,
  • Melissa Shaw,
  • Donna Shelley,
  • Ashley Shreves,
  • Jennifer Siller,
  • Elizabeth Singer,
  • Laura Steucher,
  • Kelly Szabo,
  • Andrea Torre,
  • Karen Toulson,
  • Rachel Urosek,
  • Julie Uspal,
  • Tiny Varghese,
  • Arvind Venkat,
  • Travis Wood,
  • Erin Zimny

DOI
https://doi.org/10.1136/bmjopen-2019-030099
Journal volume & issue
Vol. 9, no. 7

Abstract

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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