Randomized Evaluation of Default Access to Palliative Services

The REDAPS trial aims to generate large-scale, experimental evidence regarding the real-world
effectiveness of inpatient palliative consultative services (IPCS) and to test the
incremental effectiveness and costs of a simple, scalable method to increase IPCS utilization
among properly selected patients. The REDAPS trial will also compare the effectiveness of
different palliative care team structures and services and identify patient subgroups most
likely to benefit from IPCS. To achieve these goals, the investigators will conduct a
clinical trial at 11 Ascension Health hospitals using the same electronic health record.
Participating hospitals first contribute a minimum of 4 months of data under the control
paradigm (opt-in model), where physicians must identify patients who may benefit from
palliative care consultation and actively order such services. Then, using a stepped-wedge
design, the hospitals are randomly assigned to begin the intervention in intervals spaced
approximately 2.7 months apart. During the intervention, patients meeting consensus criteria
for eligibility for palliative care consultation are identified by the electronic health
record, a consultation is ordered by default, physicians may cancel the order after being
alerted to it, and patients or family members may decline such services. By the end of the
trial, all hospitals will have utilized the intervention paradigm of palliative care
consultation for at least 4 months. The REDAPS trial will compare outcomes (clinical,
economic, and process measures) before and after implementation within hospitals, as well as
comparisons among hospitals at given time points.

Inclusion Criteria:

1. Age 65 years or older

2. Current hospitalization of at least 3 calendar days

3. Diagnosis of one or more of the following:

- End-stage renal disease (ESRD) on dialysis

- Chronic obstructive pulmonary disease (COPD) with home oxygen dependence or 2 or
more hospitalizations in the past 12 months

- Dementia admitted from a long-term care facility or prior placement of a surgical
feeding tube or 2 or more additional hospitalizations in the past 12 months

Exclusion criteria:

1. Patients younger than 65 years old will not receive the intervention