Advance Care PlanningNCT04881968
EFFECTIVENESS: Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning by Hospitalists
A study testing Hopewell Hospitalist Video Game in people with Advance Care Planning, run by Dartmouth-Hitchcock Medical Center at 1 site in United States.
Trial summary
Hopewell Hospitalist is a theory-based adventure video game designed to increase the likelihood that a physician will engage in an advance care planning (ACP) conversation with a patient over the age of 65. Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Advance Care Planning
- What is being tested?
- Hopewell Hospitalist Video Game
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 1,261 participants
- Where
- 1 siteUnited States
- Study dates
- 15 Jul 2021to 13 Aug 2021
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Hospitalist Inclusion Criteria:
- Employed by Sound
- Not previously included in the Efficacy Trial Arm of the study.
Hospitalist Exclusion Criteria:
- Not employed by Sound
- Does not provide informed consent
- Previously included in the Efficacy Trial Arm of the study.
Trial locations and contacts
1 site in 1 country.
United States1 site
Dartmouth Hitchcock Medical Center
Lebanon, New Hampshire, 03766
About this study
Official title: Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning Conversations by Hospitalists With Older Adults
Hopewell Hospitalist is a theory-based adventure video game designed to increase the likelihood that a physician will engage in an advance care planning (ACP) conversation with a patient over the age of 65. Drawing on the theory of narrative engagement, players assume the persona of a hospitalist physician and navigate a series of clinical encounters with seriously-ill patients over the age of 65. Players experience the consequences of having (or not having) ACP conversations in a timely fashion. The planned study is a crossover phase III trial testing the effectiveness of providing physicians with a link to a free version of Hopewell Hospitalist as a means for increasing ACP rates measured by ACP billing frequency.
- Conditions
- Advance Care Planning
- Being tested
- Hopewell Hospitalist Video Game
- Keywords
- advance care planning, physician performance, serious games, narrative engagement
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Hopewell Hospitalist Video GameBehavioural
Hopewell Hospitalist is a customized theory-based adventure video game that uses narrative engagement to educate physician players on advance care planning to increase physicians' likelihood of engaging in and billing for ACP conversations.
| Study group | Role | What they receive |
|---|---|---|
| Control: Usual Care | No intervention | The control arm occurs prior to receipt of the video game intervention and reflects usual care. Each hospitalist 'crosses over' from control to intervention at a single time point. |
| Video Game Intervention | Experimental | Each hospitalist 'crosses over' from control to intervention at a single time point by receiving a link to the Hopewell Hospitalist game via email and logging in to play the video game. Receives: Behavioral: Hopewell Hospitalist Video Game |
What is being measured
The primary outcome is the main question the study is designed to answer.
Incidence of Billed Advance Care Planning
Change in physician advance care planning billing for patients over the age of 65 in the three months before and after the roll-out of the video game intervention at their hospital. Advance care planning billing is defined as the presence/absence of ACP charges (Medicare billing codes 99497 or 99498) during a physician's patient's hospitalization.
Measured: 6 months (3 months pre and 3 months post intervention)
Merit-based Incentive Payment System Advance Care Planning Quality Score
Change in the Merit-based Incentive Payment System (MIPS) self-report measure of advance care planning by enrolled hospitalists (MiPS-ACP quality score). The MiPS-ACP quality score is the percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. The quality score ranges from 0-100%, with higher scores indicating that a greater proportion of patients with an advance care plan documented in the medical record.
Measured: 6 months (3 months pre and 3 months post intervention)
Secondary outcomes (9)
Hospitalist-Managed Patient In-Hospital Mortality Rate
In-hospital mortality rate for patients managed by enrolled hospitalists.
Measured: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient 90-Day Mortality Rate
90-day mortality rate for patients managed by enrolled hospitalists.
Measured: 6 months (3 months pre and 3 months post intervention)
Sum of Resources Utilized by Hospitalist-Managed Patients
Combined sum of resources utilized by patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). It is a composite measure including: admission to ICU, receipt of life-sustaining treatment(s) including mechanical ventilation, placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis. This measure ranges from 0 to 5, where higher scores indicate greater utilization of resources during the index hospitalization.
Measured: 6 months (3 months pre and 3 months post intervention)
Incidence of Hospitalist-Managed Patient Admission to ICU
Incidence of admission to ICU for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Measured: 6 months (3 months pre and 3 months post intervention)
Incidence of Hospitalist-Managed Patient Mechanical Ventilation
Incidence of mechanical ventilation of patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Measured: 6 months (3 months pre and 3 months post intervention)
Incidence of Hospitalist-Managed Patient Receipt of Life-Sustaining Treatment(s)
Incidence of placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Measured: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient Length of Stay
Total days between admission and discharge for patients managed by enrolled hospitalists.
Measured: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient Disposition Status Type
Type of status upon discharge of patients managed by enrolled hospitalists (e.g., discharged to home, to skilled nursing, to hospice, deceased, etc.).
Measured: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient 90-Day Episode-Based Spending
Amount of total Medicare payments between index admission and 90-days for patients managed by enrolled hospitalists.
Measured: 6 months (3 months pre and 3 months post intervention)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 May 2021
- Study start15 Jul 2021
- Primary completion13 Aug 2021
- Study completion13 Aug 2021
Why it stopped: The effectiveness trial was terminated early because the intervention proved to be ineffective in generating engagement from study participants. With such low engagement we were unable to test our intervention with our proposed outcome measures.
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for Advance Care PlanningStudies of the same condition, open and under way.
- More trials run by Dartmouth-Hitchcock Medical CenterThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Sequential
- Model description
- We will email the Uniform Resource Locator (URL) to download the App with encouragement to play the game, including positive feedback from participants in the efficacy study. Receipt of the email will be our measure of intervention delivery. Each hospitalist 'crosses over' from control to intervention at a single time point.
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 1,261 participants (actual)
Sponsor and investigators
- Lead sponsor
- Dartmouth-Hitchcock Medical Center
- Sponsor type
- University, hospital or other
- Collaborators
- Sound Physicians, National Institute on Aging (NIA)
- Responsible party
- Principal investigator, Amber Barnato, Dartmouth-Hitchcock Medical Center
- Investigators
- Amber Barnato, MD, MPH, MS, Principal investigator, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine�
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04881968
- Sponsor's protocol ID
- STUDY00031186 - B
- Other IDs
- P01AG019783
- Status last verified
- Feb 2022
- First submitted
- 6 May 2021
- Last updated
- 25 Feb 2022
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: We will share de-identified participant data and supporting information with other researchers upon request to the PI.
Study at a glance
From the registry record, last updated by the sponsor on 25 Feb 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning Conversations by Hospitalists With Older Adults
- ClinicalTrials.gov ID
- NCT04881968
- Acronym / sponsor ID
- STUDY00031186 - B
- Conditions
- Advance Care Planning
- Keywords
- advance care planning, physician performance, serious games, narrative engagement
- Study type
- Interventional
- Recruitment status
- TerminatedReason stopped: The effectiveness trial was terminated early because the intervention proved to be ineffective in generating engagement from study participants. With such low engagement we were unable to test our intervention with our proposed outcome measures.
- Enrolment
- 1,261 participants (actual)
- Lead sponsor
- Dartmouth-Hitchcock Medical CenterUniversity, hospital or other
- Collaborators
- Sound Physicians, National Institute on Aging (NIA)
- Study start
- 15 Jul 2021 (actual)
- Primary completion
- 13 Aug 2021 (actual)
- Study completion
- 13 Aug 2021 (actual)
- First posted
- 11 May 2021 (actual)
- Results
- Posted 2 Feb 2022
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Hopewell Hospitalist is a theory-based adventure video game designed to increase the likelihood that a physician will engage in an advance care planning (ACP) conversation with a patient over the age of 65. Drawing on the theory of narrative engagement, players assume the persona of a hospitalist physician and navigate a series of clinical encounters with seriously-ill patients over the age of 65. Players experience the consequences of having (or not having) ACP conversations in a timely fashion. The planned study is a crossover phase III trial testing the effectiveness of providing physicians with a link to a free version of Hopewell Hospitalist as a means for increasing ACP rates measured by ACP billing frequency.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Sequential
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- We will email the Uniform Resource Locator (URL) to download the App with encouragement to play the game, including positive feedback from participants in the efficacy study. Receipt of the email will be our measure of intervention delivery. Each hospitalist 'crosses over' from control to intervention at a single time point.
| Arm | Type | Receives |
|---|---|---|
| Control: Usual Care | No intervention | –The control arm occurs prior to receipt of the video game intervention and reflects usual care. Each hospitalist 'crosses over' from control to intervention at a single time point. |
| Video Game Intervention | Experimental | Behavioral: Hopewell Hospitalist Video GameEach hospitalist 'crosses over' from control to intervention at a single time point by receiving a link to the Hopewell Hospitalist game via email and logging in to play the video game. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Hopewell Hospitalist Video GameHopewell Hospitalist is a customized theory-based adventure video game that uses narrative engagement to educate physician players on advance care planning to increase physicians' likelihood of engaging in and billing for ACP conversations. | Behavioural | Video Game Intervention |
Primary outcome
Incidence of Billed Advance Care Planning
Time frame: 6 months (3 months pre and 3 months post intervention)
Change in physician advance care planning billing for patients over the age of 65 in the three months before and after the roll-out of the video game intervention at their hospital. Advance care planning billing is defined as the presence/absence of ACP charges (Medicare billing codes 99497 or 99498) during a physician's patient's hospitalization.
Merit-based Incentive Payment System Advance Care Planning Quality Score
Time frame: 6 months (3 months pre and 3 months post intervention)
Change in the Merit-based Incentive Payment System (MIPS) self-report measure of advance care planning by enrolled hospitalists (MiPS-ACP quality score). The MiPS-ACP quality score is the percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. The quality score ranges from 0-100%, with higher scores indicating that a greater proportion of patients with an advance care plan documented in the medical record.
9 secondary outcomes
Hospitalist-Managed Patient In-Hospital Mortality Rate
Time frame: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient 90-Day Mortality Rate
Time frame: 6 months (3 months pre and 3 months post intervention)
Sum of Resources Utilized by Hospitalist-Managed Patients
Time frame: 6 months (3 months pre and 3 months post intervention)
Incidence of Hospitalist-Managed Patient Admission to ICU
Time frame: 6 months (3 months pre and 3 months post intervention)
Incidence of Hospitalist-Managed Patient Mechanical Ventilation
Time frame: 6 months (3 months pre and 3 months post intervention)
Incidence of Hospitalist-Managed Patient Receipt of Life-Sustaining Treatment(s)
Time frame: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient Length of Stay
Time frame: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient Disposition Status Type
Time frame: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient 90-Day Episode-Based Spending
Time frame: 6 months (3 months pre and 3 months post intervention)
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 25 Feb 2022.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Individual participant dataSharing planned: Yes. We will share de-identified participant data and supporting information with other researchers upon request to the PI.
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Development and Evaluation of a Disease-oriented Scenario Game to Promote ACP Among Older Adults and Family Caregivers
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Using a Conversation Game to Engage Native American Washoe Tribe Members in Advance Care Planning: Preparation for a Clinical Trial
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Amber Barnato, MD, MPH, MS principal investigator
Dartmouth-Hitchcock Medical Center and Geisel School of Medicine�
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Hopewell Hospitalist Video Game in people with Advance Care Planning, run by Dartmouth-Hitchcock Medical Center at 1 site in United States.
The full registered description is in the About this study section and the official record.
Is this clinical trial currently recruiting?
The record says: stopped early, as of the sponsor's last update on 25 Feb 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 2 Feb 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Incidence of Billed Advance Care Planning (time frame: 6 months (3 months pre and 3 months post intervention)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Feb 2022.