PRP159: Strategies to Improve Patient Recruitment in a Practice-Based Research Network Advance Care Planning Study

Megan Schmidt, MEd, MPH; Jeanette Daly, PhD; Yinghui Xu, MS; Barcey Levy, MD, PhD


Context:In March 2019, recruitment began in the Iowa Research Network for a PCORI-funded Advance Care Planning (ACP) Study to be conducted in 7 practice-based research networks across the United States and Canada. The parent study trained clinicians and nursing staff in serious illness conversations and requested they refer eligible patients. Eligible patients were those with serious illness or frailty expected to live 1-2 years. Clinicians indicated it was difficult to identify eligible patients. This study aimed to find better methods for increasing patient recruitment for the ACP Study. Objectives:1)To assess whether flagging patients for clinicians using the Gagne Index (validated mortality prediction tool) and Epic SlicerDicer (an electronic medical record tool to generate customized patient data reports) increases patient referrals and 2)To assess clinician and nursing staff perceptions of implemented strategies. Study Design:Quasi-experimental trial. Setting:Three University of Iowa Health Care outpatient family medicine clinics. Dataset:Epic SlicerDicer reports and clinician and nursing staff perceptions of strategies to improve recruitment. Population:Clinicians, nursing staff, and potential subjects. Intervention:Research team brainstormed and implemented strategies to increase patient referrals. One strategy involved use of the Gagne Index to generate a list of potentially appropriate patients in SlicerDicer. Outcome Measures:Number of patient referrals received before and after the intervention. Number of patient referrals from those who were flagged in Epic using SlicerDicer. Clinician and nursing staff perceptions of implemented strategies. Results:In progress. Recruitment ends June 2020. From March 2019 through September 2019 (7 months), before implementation of targeted strategies, 26 patients were referred. From October 2019 through March 2020 (6 months), after strategy implementation, 54 patients were referred. After strategy implementation, clinicians and nursing staff were notified that 311 unique patients with upcoming appointments were potentially eligible, but only 32 (10%) out of 311 identified patients were referred. Clinician and nursing staff perceptions data collection in progress. Expected Outcomes: There will be an increase in study referrals after implementation of strategies. Clinical staff will identify one or two strategies that they found helpful. Funding: Patient-Centered Outcomes Research Institute Award PLC-1609-36277

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