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| ID | Type | Description | Link |
|---|---|---|---|
| P01AG019783 | U.S. NIH Grant/Contract | View source |
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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.
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| Name | Class |
|---|---|
| Sound Physicians | OTHER |
| National Institute on Aging (NIA) | NIH |
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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 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. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Hopewell Hospitalist Video Game | Behavioral | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 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. | 6 months (3 months pre and 3 months post intervention) |
| Measure | Description | Time Frame |
|---|---|---|
| Hospitalist-Managed Patient In-Hospital Mortality Rate | In-hospital mortality rate for patients managed by enrolled hospitalists. | 6 months (3 months pre and 3 months post intervention) |
| Hospitalist-Managed Patient 90-Day Mortality Rate |
| Measure | Description | Time Frame |
|---|---|---|
| Hopewell Hospitalist - Apple App Store and Google Analytics | Number of unique downloads for the HH game will be provided by the Apple App store. Using Google Analytics we will be able to discern time spent playing the game for each individual hospitalist using their unique log-in passphrase. | 3 months |
Hospitalist Inclusion Criteria:
Hospitalist Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Amber Barnato, MD, MPH, MS | Dartmouth-Hitchcock Medical Center and Geisel School of Medicine� | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Dartmouth Hitchcock Medical Center | Lebanon | New Hampshire | 03766 | United States |
We will share de-identified participant data and supporting information with other researchers upon request to the PI.
Upon publication of the planned manuscripts. Data will be retained through February 2028.
Data will require completion of a data use agreement with Dartmouth.
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Individuals who received an invitation via an email from the Chief Experience Officer at Sound Physicians were considered enrolled. In this pre/post study design, each participant would be assigned to both the Control Arm, in which we would analyze ACP billing 90 days prior to the intervention, and the Video Game Intervention Arm, in which we would analyze ACP billing 90 days post intervention.
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| ID | Title | Description |
|---|---|---|
| FG000 | Entire Study Population | Each hospitalist in our study population '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. Hopewell Hospitalist Video Game: 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. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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| ID | Title | Description |
|---|---|---|
| BG000 | Entire Study Population | Each hospitalist in our study population '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. Hopewell Hospitalist Video Game: 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. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Customized | We did not collect information regarding age from study participants. |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | 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. | We are reporting on all study participants in this section. No data was collected for the Primary Outcome: Incidence of Billed Advance Care Planning. | Posted | 6 months (3 months pre and 3 months post intervention) |
|
Adverse events information was not collected during this study. The intervention involved two emails sent to physicians at eligible Sound Hospitals containing a link to an educational video game.
Total Number of Participants at Risk is zero (0) as mortality, serious and other [non-serious] adverse events were not collected or assessed as part of the study.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Entire Study Population | Adverse events information was not collected during this study. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Amber Barnato | The Dartmouth Institute | 603-646-5237 | amber.barnato@dartmouth.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 22, 2021 | Jan 4, 2022 | Prot_SAP_000.pdf |
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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.
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A physician's treatment assignment will be masked during analysis.
|
90-day mortality rate for patients managed by enrolled hospitalists.
| 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. | 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). | 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). | 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). | 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. | 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.). | 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. | 6 months (3 months pre and 3 months post intervention) |
We did not collect information regarding age from study participants.
| Number |
| participants |
|
| Sex: Female, Male | We did not collect information regarding sex from study participants. | We did not collect information regarding sex from study participants. | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | We did not collect information regarding race/ethnicity from study participants. | We did not collect information regarding race/ethnicity from study participants. | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Units | Counts |
|---|
| Participants |
|
| Primary | 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. | We are reporting on all study participants in this section. No data was collected for the Primary Outcome: Merit-based Incentive Payment System Advance Care Planning Quality Score. | Posted | 6 months (3 months pre and 3 months post intervention) |
|
|
| Secondary | Hospitalist-Managed Patient In-Hospital Mortality Rate | In-hospital mortality rate for patients managed by enrolled hospitalists. | We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hospitalist-Managed Patient In-Hospital Mortality Rate. | Posted | 6 months (3 months pre and 3 months post intervention) |
|
|
| Secondary | Hospitalist-Managed Patient 90-Day Mortality Rate | 90-day mortality rate for patients managed by enrolled hospitalists. | We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hospitalist-Managed Patient 90-Day Mortality Rate. | Posted | 6 months (3 months pre and 3 months post intervention) |
|
|
| Secondary | 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. | We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Sum of Resources Utilized by Hospitalist-Managed Patients. | Posted | 6 months (3 months pre and 3 months post intervention) |
|
|
| Secondary | 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). | We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Incidence of Hospitalist-Managed Patient Admission to ICU. | Posted | 6 months (3 months pre and 3 months post intervention) |
|
|
| Secondary | 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). | We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Incidence of Hospitalist-Managed Patient Mechanical Ventilation. | Posted | 6 months (3 months pre and 3 months post intervention) |
|
|
| Secondary | 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). | We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Incidence of Hospitalist-Managed Patient Receipt of Life-Sustaining Treatment(s). | Posted | 6 months (3 months pre and 3 months post intervention) |
|
|
| Secondary | Hospitalist-Managed Patient Length of Stay | Total days between admission and discharge for patients managed by enrolled hospitalists. | We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hospitalist-Managed Patient Length of Stay | Posted | 6 months (3 months pre and 3 months post intervention) |
|
|
| Secondary | 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.). | We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hospitalist-Managed Patient Disposition Status Type | Posted | 6 months (3 months pre and 3 months post intervention) |
|
|
| Secondary | 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. | We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hospitalist-Managed Patient 90-Day Episode-Based Spending | Posted | 6 months (3 months pre and 3 months post intervention) |
|
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| Other Pre-specified | Hopewell Hospitalist - Apple App Store and Google Analytics | Number of unique downloads for the HH game will be provided by the Apple App store. Using Google Analytics we will be able to discern time spent playing the game for each individual hospitalist using their unique log-in passphrase. | We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hopewell Hospitalist - Apple App Store and Google Analytics | Posted | 3 months |
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