A Pragmatic Trial of an Active Choice Nudge for Generalist or Specialist Palliative Care for Seriously Ill Inpatients

A Pragmatic Trial of an Active Choice Nudge for Generalist or Specialist Palliative Care for Seriously Ill Inpatients: The Palliative Connect Trial

This stepped-wedge, cluster-randomized pragmatic trial among six hospitals at University of Pennsylvania Health System will test a behavioral intervention embedded within the electronic health record that nudges hospital clinicians to either provide palliative care (PC) themselves (generalist PC) or consult specialists (specialty PC) for inpatients at high risk of death within 6 months. The trial will evaluate the intervention's effect compared to usual care on the primary outcome of hospital-free days through 6 months, and other patient-centered, clinical, and economic outcomes. The trial also includes an embedded mixed methods study to understand clinician and hospital contextual factors that influence the intervention's uptake.

Inclusion Criteria:

• Age 18 or older
• Inpatient or observation admission status at a study hospital
• Predicted 6-month mortality risk moderate (e.g., ≥40%) or higher

Exclusion Criteria:

• Under 18 years of age
• Inpatient primary service: hospice, rehabilitation, obstetrics, psychiatry
• Patients that have died or been discharged before 0800 on hospital day 3 when the mortality risk is generated and enrollment occurs