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Completed

NCT Number: NCT03724695

Advanced Heart Care at Home

End-of-life (EOL) care for heart failure (HF) patients includes high healthcare utilization and costs, in part due to the lack of integration of optimal HF management and home-based palliative care. In a pilot quality improvement project of clinician "nudges" to enroll seriously ill HF patients in a home-based, integrated HF and palliative care platform, the investigators demonstrated decreased healthcare utilization and costs and increased hospice utilization among seriously ill HF patients. The investigators propose a pragmatic randomized trial for clinicians of seriously ill HF patients admitted to three University of Pennsylvania Health System Hospitals, randomly assigning an opt-in approach (usual care) versus a "nudge" or opt-out approach of a visit from an Advanced Heart Care at Home (AHCAH) liaison to clinicians of eligible patients to discuss and enroll in the AHCAH program, to rigorously and scientifically evaluate clinical, utilization, and cost outcomes among high-risk HF patients at the EOL, and to promote physician uptake of best practices.

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Key information

Conditions

Palliative Care Behavior Cardiovascular Diseases Health Behavior Health Care Utilization Heart Diseases Heart Failure Patient Acceptance of Health Care Quality Improvement Treatment Adherence and Compliance

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Perelman Center for Advanced Medicine

Philadelphia, Pennsylvania, 191014, United States

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • At least 18 years of age
  • Reside within Caring Way's geographic catchment
  • Heart Failure ICD code from any previous healthcare encounter (inpatient or outpatient) in the 12 months prior to index hospitalization
  • Admitted to a cardiology or hospitalist service
  • Palliative Connect score greater than 0.3
  • Index hospitalization during study period

Exclusion criteria

  • Less than 18 years of age
  • Pregnant women
  • Incarcerated patients
  • Homeless patients
  • Reside outside of Caring Way's geographic catchment
  • Patients without an identifiable primary physician for AHCAH staff to communicate with as determined by the AHCAH liaison via EPIC
  • Prior hospitalization during study period

Treatment and study plan

Clinician nudge or opt out approach for AHCAH liaison visit

Other

This study is a "nudge" or opt-out approach of an AHCAH liaison visit to eligible seriously ill HF patients prior to hospital discharge to discuss the AHCAH program and to subsequently facilitate enrolling them in the AHCAH program if they are amenable, compared to the opt-in approach (usual care).

Primary outcomes

  1. Acute care days

    Time frame: 6-12 months

    number of hospitalization days in the University of Pennsylvania Health System

Secondary outcomes

  1. Mortality

    Time frame: 6-12 months

    number of patient deaths after enrollment in AHCAH

  2. Hospice enrollment

    Time frame: 6-12 months

    number of patients who transition from AHCAH to hospice

  3. hospice length of service

    Time frame: 6-12 months

    If transitioned to hospice from AHCAH, number of days on hospice

  4. University of Pennsylvania Health System total acute care cost

    Time frame: 6-12 months

    cost of emergency department visit and/or hospitalization within the UPHS Health system

  5. Pennsylvania total acute care cost

    Time frame: 6-12 months

    cost of emergency department visit and/or hospitalization within Pennsylvania

  6. University of Pennsylvania Health System number of intensive care unit days

    Time frame: 6-12 months

    number of days hospitalized in an intensive care unit within UPHS

  7. Pennsylvania number of intensive care unit days

    Time frame: 6-12 months

    number of days hospitalized in an intensive care unit within hospitals in Pennsylvania

  8. University of Pennsylvania Health System emergency department visits

    Time frame: 6-12 months

    number of emergency department visits within UPHS

  9. Pennsylvania emergency department visits

    Time frame: 6-12 months

    number of emergency department visits within hospitals in Pennsylvania

  10. Use of intravenous diuretics at home

    Time frame: 6-12 months

    Prescription and delivery of intravenous diuretics from Penn Home Infusion Therapy Services and administration of intravenous diuretics by AHCAH nurse

  11. new documentation of goals of care

    Time frame: 6-12 months

    Advance Care Planning documentation within electronic medical record

Sponsors and collaborators

Lead sponsor

University of Pennsylvania

Other

Collaborators

  • Independence Blue Cross
  • Penn Medicine Center for Health Care Innovation

Registry information

Official study title

Advanced Heart Care at Home (AHCAH); a Pragmatic Randomized Trial for Clinicians Nudged to AHCAH, a Heart Failure Specific Home Palliative Care Services

Acronym: AHCAH

Important dates

Study start
2018
Primary completion
2024
Study completion
2024
First posted
Oct 30, 2018
Registry last updated
Jan 26, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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