The quality of intensive care unit (ICU)-based palliative care is highly variable, particularly for the 2 million older adults admitted annually to ICUs. However, improving care quality on a broad scale with the efficient delivery of patient-centered, need-targeted palliative care is challenging because of logistical and technological barriers. To address these care delivery barriers among older ICU patients, we developed a mobile app platform called PCplanner (Palliative Care planner). PCplanner automates the identification of high-risk patients (e.g., dementia, declining health status, poor functioning) by directly capturing data from electronic health record (EHR) systems, cultivates family engagement with supportive information and a digital system for self-report of actual needs, and facilitates the delivery of care to those with a high burden of need by coordinating collaboration between ICU teams and palliative care specialists. In pilot comparison to a standard palliative care control, the intervention reduced unmet needs, psychological distress, and length of stay and increased goal concordant care, communication, and hospice utilization. While these data are compelling, an efficacy evaluation of PCplanner is needed. Therefore, we propose to enroll 250 patients, 270 family caregivers, and 215 physicians and nurses from academic and community settings in a 5-year project with 3 aims: (1) Optimize the fully realized PCplanner platform?s usability for older adults, (2) Test the efficacy of PCplanner-augmented collaborative palliative care vs usual care in a randomized clinical trial (RCT) with 3-month follow up, and (3) Explore family caregiver and clinician experiences using mixed methods to understand intervention mechanisms as well as implementation barriers within diverse case contexts. We hypothesize that compared to usual care, PCplanner will reduce family caregivers? unmet needs and psychological distress, increase the frequency of goal concordant treatment among older adult patients, and reduce hospital length of stay. PCplanner represents a potentially transformative, paradigm-changing approach to delivering scalable personalized ICU-based palliative care for older adults: it acts as infrastructure for a replicable collaborative care model, provides a state of the art technological build that enables real-time direct data capture from any hospital?s EHR (i.e., interoperability), and automates the measurement of patient- / family-centered outcomes and quality indicators?all areas that are lacking in current practice. This theoretically grounded project?s numerous technological and conceptual innovations address research priorities detailed by the NIH (Palliative Care Priorities Workgroup), the Office of the National Coordinator (Connecting Health and Care for the Nation Roadmap), and the National Academy of Medicine (Vital Directions for Health Care Services initiative). We can perform this research successfully because of our multidisciplinary team?s expertise and the enthusiastic support of our institution and its clinicians.
Nearly 20% of all deaths in the United States happen in an intensive care unit (ICU). Unfortunately, many older ICU patients and their family caregivers often do not receive timely palliative care assistance that focuses on their actual needs. To address this problem, this proposal aims to test a mobile app platform called PCplanner. PCplanner uses computerized medical record information and families? own reports of their needs to quickly determine which patients and families require palliative care?and then helps clinicians to quickly address these needs as a team. We believe that this will improve outcomes for patients, families, and clinicians alike.
