Nudging Effective and Equitable Delivery of Specialty Palliative Care (NEEDS-PC)

Millions of Americans living with serious illness experience burdensome symptoms and receive goal-discordant care that diminishes their quality of life. Palliative care (PC) is widely endorsed to address these pervasive problems with serious illness care, with its benefits for patients, caregivers, and health systems having been demonstrated in many randomized trials. Despite this, PC delivery remains inefficient and inequitable among patients with serious illness, largely due to clinicians’ challenges in identifying which patients are most likely to benefit from it. To address these challenges, many hospitals have sought to overcome these key barriers by implementing standard referral criteria “triggers” to facilitate patient identification. However, these triggers are commonly based on specific diagnoses or patient locations, such as intensive care units, and therefore may not adequately reflect a patient’s palliative care needs.

This trial evaluates an automated, electronic health record (EHR)-based palliative care needs trigger at nine hospitals within MedStar Health, assessing its impact on approximately 18,000 seriously ill inpatients. Over 108 weeks, in a randomly assigned sequence, hospitals transition from usual care to implementing two automated PC needs triggered alerts. The first alert nudges clinicians to place an order for specialty PC. Hospitals later adopt the second alert, which notifies hospital clinicians of a default PC consult order with an opt-out option.

The trial will compare the interventions’ effects to usual care, focusing on completed PC consults during the hospital encounter and other patient-centered and clinical outcomes. The trial also includes an embedded mixed methods study to explore factors influencing the effectiveness and equity of intervention implementation.

Our central hypotheses are that an EHR-based PC needs trigger will improve both patient-centered outcomes and the equity of PC delivery compared to usual care, and that combining this trigger with default PC consult orders will improve these outcomes further compared to the trigger alone.

Conducted in an established collaboration between Penn’s Palliative and Advanced Illness Research (PAIR) Center, MedStar Health, and Oracle Cerner Health (the second-most common EHR in U.S. hospitals), our study seeks to close crucial gaps in our understanding of how to deliver palliative care effectively and equitably.

Learn more about the NEEDS-PC Trial at MedStar Health.

We expect to share initial results in 2027-2028.

MedStar Health

National Institutes of Health
National Institute of Aging