Evidence map›Paper›PMID 32727393›Full record

ArticleBMC geriatrics2020

A stepped-wedge randomised-controlled trial assessing the implementation, impact and costs of a prospective feedback loop to promote appropriate care and treatment for older patients in acute hospitals at the end of life: study protocol.

Xing J Lee, Alison Farrington, Hannah Carter, Carla Shield, Nicholas Graves, Steven M McPhail, Gillian Harvey, Ben P White, Lindy Willmott, Magnolia Cardona and 3 more

Open access · goldAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC geriatrics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.7field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 11 citations in OpenAlex.

  1. Trial
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  6. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 4 institutions in 2 countries.

Xing J LeeFaculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia. xj.lee@qut.edu.au.ORCID 0000-0002-8803-2810
Alison FarringtonFaculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia.
Hannah CarterFaculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia.
Carla ShieldFaculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia.
Nicholas GravesDuke-NUS Postgraduate Medical School, National University of Singapore, Singapore, Singapore.
Steven M McPhailFaculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia.
Gillian HarveyFaculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia.
Ben P WhiteAustralia Centre for Heath Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia.
Lindy WillmottAustralia Centre for Heath Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia.
Magnolia CardonaGold Coast University Hospital, Southport, Queensland, Australia.
Ken HillmanSimpson Centre for Health Services Research, South West Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.
Leonie CallawayFaculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Adrian G BarnettFaculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia.
Queensland University of Technology · AUBond University · AUNational University of Singapore · SGUNSW Sydney · AU

Funding

National Health and Medical Research Council GNT1151923
6 · The paper itself

Abstract

backgroundHospitalisation rates for the older population have been increasing with end-of-life care becoming a more medicalised and costly experience. There is evidence that some of these patients received non-beneficial treatment during their final hospitalisation with a third of the non-beneficial treatment duration spent in intensive care units. This study aims to increase appropriate care and treatment decisions and pathways for older patients at the end of life in Australia. This study will implement and evaluate a prospective feedback loop and tailored clinical response intervention at three hospitals in Queensland, Australia.

methodsA stepped-wedge cluster randomised trial will be conducted with up to 21 clinical teams in three acute hospitals over 70 weeks. The study involves clinical teams providing care to patients aged 75 years or older, who are prospectively identified to be at risk of non-beneficial treatment using two validated tools for detecting death and deterioration risks. The intervention's feedback loop will provide the teams with a summary of these patients' risk profiles as a stimulus for a tailored clinical response in the intervention phase. The Consolidated Framework for Implementation Research will be used to inform the intervention's implementation and process evaluation. The study will determine the impact of the intervention on patient outcomes related to appropriate care and treatment at the end of life in hospitals, as well as the associated healthcare resource use and costs. The primary outcome is the proportion of patients who are admitted to intensive care units. A process evaluation will be carried out to assess the implementation, mechanisms of impact, and contextual barriers and enablers of the intervention. DISCUSSION: This intervention is expected to have a positive impact on the care of older patients near the end of life, specifically to improve clinical decision-making about treatment pathways and what constitutes appropriate care for these patients. These will reduce the incidence of non-beneficial treatment, and improve the efficiency of hospital resources and quality of care. The process evaluation results will be useful to inform subsequent intervention implementation at other hospitals.

trial registrationAustralia New Zealand Clinical Trial Registry (ANZCTR), ACTRN12619000675123p (approved 6 May 2019).

Indexed as

DeathHospitalsAgedAustraliaFeedbackHumansProspective StudiesQueenslandRandomized Controlled Trials as TopicEnd-of-life careGeriatricsHigh-risk, older populationIntensive careMedical futilityNon-beneficial treatmentProspective feedback loop interventionRisk assessmentStepped-wedge cluster randomised trial

Identifiers

PMID32727393
PMCPMC7392836
OpenAlexW3046058580

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.