TY - JOUR
T1 - Rationale and design of the randomized evaluation of default access to palliative services (REDAPS) trial
AU - Courtright, Katherine R.
AU - Madden, Vanessa
AU - Gabler, Nicole B.
AU - Cooney, Elizabeth
AU - Small, Dylan S.
AU - Troxel, Andrea
AU - Casarett, David
AU - Ersek, Mary
AU - Cassel, J. Brian
AU - Hersch Nicholas, Lauren
AU - Escobar, Gabriel
AU - Hill, Sarah H.
AU - O'Brien, Dan
AU - Vogel, Mark
AU - Halpern, Scott D.
N1 - Publisher Copyright:
Copyright © 2016 by the American Thoracic Society.
PY - 2016/9
Y1 - 2016/9
N2 - The substantial nationwide investment in inpatient palliative care services stems from their great promise to improve patient-centered outcomes and reduce costs. However, robust experimental evidence of these benefits is lacking. The Randomized Evaluation of Default Access to Palliative Services (REDAPS) study is a pragmatic, steppedwedge, cluster randomized trial designed to test the efficacy and costs of specialized palliative care consultative services for hospitalized patients with advanced chronic obstructive pulmonary disease, dementia, or end-stage renal disease, as well as the overall effectiveness of ordering such services by default. Additional aims are to identify the types of services that are most beneficial and the types of patients most likely to benefit, including comparisons between ward and intensive care unit patients. We hypothesize that patientcentered outcomes can be improved without increasing costs by simply changing the default option for palliative care consultation from opt-in to opt-out for patients with life-limiting illnesses. Patients aged 65 years or older are enrolled at 11 hospitals using an integrated electronic health record. As a pragmatic trial designed to enroll between 12,000 and 15,000 patients, eligibility is determined using a validated, electronic health record-based algorithm, and all outcomes are captured via the electronic health record and billing systems data. The time at which each hospital transitions from control, opt-in palliative care consultation to intervention, opt-out consultation is randomly assigned. The primary outcome is a composite measure of in-hospital mortality and length of stay. Secondary outcomes include palliative care process measures and clinical and economic outcomes. Clinical trial registered with www.clinicaltrials.gov (NCT02505035).
AB - The substantial nationwide investment in inpatient palliative care services stems from their great promise to improve patient-centered outcomes and reduce costs. However, robust experimental evidence of these benefits is lacking. The Randomized Evaluation of Default Access to Palliative Services (REDAPS) study is a pragmatic, steppedwedge, cluster randomized trial designed to test the efficacy and costs of specialized palliative care consultative services for hospitalized patients with advanced chronic obstructive pulmonary disease, dementia, or end-stage renal disease, as well as the overall effectiveness of ordering such services by default. Additional aims are to identify the types of services that are most beneficial and the types of patients most likely to benefit, including comparisons between ward and intensive care unit patients. We hypothesize that patientcentered outcomes can be improved without increasing costs by simply changing the default option for palliative care consultation from opt-in to opt-out for patients with life-limiting illnesses. Patients aged 65 years or older are enrolled at 11 hospitals using an integrated electronic health record. As a pragmatic trial designed to enroll between 12,000 and 15,000 patients, eligibility is determined using a validated, electronic health record-based algorithm, and all outcomes are captured via the electronic health record and billing systems data. The time at which each hospital transitions from control, opt-in palliative care consultation to intervention, opt-out consultation is randomly assigned. The primary outcome is a composite measure of in-hospital mortality and length of stay. Secondary outcomes include palliative care process measures and clinical and economic outcomes. Clinical trial registered with www.clinicaltrials.gov (NCT02505035).
KW - Behavioral economics
KW - Electronic health records
KW - Palliative care
KW - Pragmatic clinical trial
UR - http://www.scopus.com/inward/record.url?scp=84989288218&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84989288218&partnerID=8YFLogxK
U2 - 10.1513/AnnalsATS.201604-308OT
DO - 10.1513/AnnalsATS.201604-308OT
M3 - Article
C2 - 27348271
AN - SCOPUS:84989288218
SN - 2325-6621
VL - 13
SP - 1629
EP - 1639
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 9
ER -