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 study evaluates an automated, electronic health record (EHR)-based palliative care trigger across nine hospitals in the MedStar health system, assessing its impact on 64,000 seriously ill patients. Over 39 months, the study transitions hospitals from usual care, to implementing automated PC triggers and default consult orders, aiming to enhance care equity and increase hospital-free days. This intervention’s effectiveness and implementation are measured using patient-centered outcomes and hospital collected metrics. Conducted in an established collaboration between Penn’s Palliative and Advanced Illness Research (PAIR) Center, MedStar Health, and 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.

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.

MedStar Health

National Institutes of Health
National Institute of Aging