- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03028805
Study of Automated Care Pathway for Patients With Chronic Obstructive Pulmonary Disease (COPD) (EPICPath)
Early Patient Identification and Care Pathway for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial of Informatics Enhanced Hospital Admission
Study Overview
Status
Intervention / Treatment
Detailed Description
This is a single-center, single-blinded, 2x2 factorial randomized controlled trial to test both automated order set inclusion and evidence-based order set design with end user testing on order set use and clinical outcomes for adult patients admitted to the hospital with acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD).
First, the investigators will develop a predictive model to identify patients admitted to the hospital with COPD exacerbations based on retrospective data, but limited to data that is available in real-time at admission.
Second, 1,000 admissions to UCSF Medical Center of adults predicted to have COPD by the predictive algorithm will be prospectively block randomized by encounter to automatic inclusion of a COPD order set in the admission orders or usual care. Providers caring for patients in both arms of the trial can independently search for and use a COPD order set. Any provider using a COPD order set in either arm will also be randomized to see two versions of the order set. The first is a static list of orders, and the second is dynamic, meaning that orders will display only when appropriate. For example, a patient who just had a chest x-ray does not need a routine repeat test. The dynamic order set will show the provider that the x-ray was completed at a specific time and will not display a prompt for a repeat test. Providers can, of course, still order anything they deem clinically appropriate, and may choose to order a repeat x-ray for a patient with a change in clinical status.
The components of the order set are based on international guidelines from the Global Initiative for Chronic Lung Disease (GOLD initiative, a collaboration between the National Heart, Lung, and Blood Institute and the World Health Organization) and a multi-stakeholder working group at UCSF including two hospitalists, two pulmonologists, two transitional care nurse specialists, one advanced practice nurse, one pharmacist, one respiratory therapist, one physical therapist, and one nurse.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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California
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San Francisco, California, United States, 94143
- University of California, San Francisco
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients 18 years old or greater admitted to the Hospital Medicine service at UCSF Medical Center who meet criteria as determined by predictive model to be likely admissions for COPD exacerbation.
Exclusion Criteria:
- Patients admitted to other clinical services at UCSF Medical Center.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Usual care and order set A
Usual care.
Providers may still search for a COPD order set, and in this arm will see version A, the static list of orders, which is the current state.
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|
Active Comparator: Usual care and order set B
Usual care in the sense that COPD orders are not automatically included in admission orders despite likelihood of a COPD admission based on the predictive model.
However, providers may still search for a COPD order set, and in this arm will see version B, the dynamic list of orders that has been end user tested prior to launch.
|
Use of a dynamic order set that has been end-user tested prior to launch rather than designed centrally by a committee to test use of order set components.
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Active Comparator: Automatic inclusion and order set A
COPD order set is automatically included in admission orders as a static list.
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Use of real-time data to identify a population of patients with COPD and prompt improved adherence to evidence-based guidelines through the automatic inclusion of a COPD order set in the admission orders.
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Active Comparator: Automatic inclusion and order set B
COPD order set is automatically included in admission orders as a dynamic and end user tested version.
|
Use of a dynamic order set that has been end-user tested prior to launch rather than designed centrally by a committee to test use of order set components.
Use of real-time data to identify a population of patients with COPD and prompt improved adherence to evidence-based guidelines through the automatic inclusion of a COPD order set in the admission orders.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Use of evidence-based COPD order set
Time Frame: one year
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Proportion of admissions for COPD exacerbation that use the COPD order set
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one year
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Average length of stay
Time Frame: one year
|
one year
|
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Number of inpatient encounters
Time Frame: one year
|
one year
|
|
30-day readmission rates
Time Frame: one year
|
one year
|
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Mortality
Time Frame: one year
|
one year
|
|
Intubations
Time Frame: one year
|
one year
|
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Code blue events
Time Frame: one year
|
one year
|
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ICU admissions
Time Frame: one year
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one year
|
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Outpatient utilization
Time Frame: one year
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Encounters for primary care clinic, Pulmonary clinic, Emergency Department or observation during 12 month follow-up
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one year
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Discharge Disposition
Time Frame: one year
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Proportion of patients discharged to home, home with home health services, or to a facility (includes skilled nursing, acute rehabilitation, sub-acute, long term acute care, and other acute care facilities)
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one year
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Proportion of enrolled patients billed for COPD related ICD-10 codes for primary or secondary diagnosis.
Time Frame: one year
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ICD-10 codes as described by PRIME program, California's Medicaid 1115 Waiver
|
one year
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Total costs of care
Time Frame: one year
|
one year
|
Collaborators and Investigators
Investigators
- Principal Investigator: Ari Hoffman, MD, University of California, San Francisco
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 16-19504
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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