EFFECTIVENESS: Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning by Hospitalists

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.

Study Overview

• Status: Terminated
• Conditions: Advance Care Planning
• Intervention / Treatment: Behavioral: Hopewell Hospitalist Video Game

• Study Type: Interventional
• Enrollment (Actual): 1261
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New Hampshire
    • Lebanon, New Hampshire, United States, 03766
      • Dartmouth Hitchcock Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Sequential Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control: Usual Care; 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.
Experimental: Video Game Intervention; 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.	Behavioral: 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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)

Secondary Outcome Measures

Outcome Measure	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	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)

Other Outcome Measures

Outcome Measure	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

Collaborators and Investigators

• Sponsor: Dartmouth-Hitchcock Medical Center
• Collaborators: National Institute on Aging (NIA); Sound Physicians
• Investigators: Principal Investigator: Amber Barnato, MD, MPH, MS, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine�

Study record dates

Study Major Dates

• Study Start (Actual): July 15, 2021
• Primary Completion (Actual): August 13, 2021
• Study Completion (Actual): August 13, 2021

Study Registration Dates

• First Submitted: May 6, 2021
• First Submitted That Met QC Criteria: May 6, 2021
• First Posted (Actual): May 11, 2021

Study Record Updates

• Last Update Posted (Actual): February 25, 2022
• Last Update Submitted That Met QC Criteria: February 11, 2022
• Last Verified: February 1, 2022

More Information

Terms related to this study

• Keywords: advance care planning; serious games; physician performance; narrative engagement
• Other Study ID Numbers: STUDY00031186 - B; P01AG019783 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: We will share de-identified participant data and supporting information with other researchers upon request to the PI.
• IPD Sharing Time Frame: Upon publication of the planned manuscripts. Data will be retained through February 2028.
• IPD Sharing Access Criteria: Data will require completion of a data use agreement with Dartmouth.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No