UH3 Project: Primary Palliative Care for Emergency Medicine (PRIM-ER)
Overview
Principal Investigators:
Sponsoring Institution: New York University Grossman School of Medicine
Collaborators:
- Allegheny Health Network
- Baystate Health
- Beaumont Health System
- Brigham and Women’s/DRCI+
- Christiana Care Health System
- Henry Ford Health System
- Icahn School of Medicine at Mount Sinai
- Mayo Clinic Health System
- New York University Grossman School of Medicine
- Ochsner Health System
- Rutgers New Jersey Medical School
- The Ohio State University
- University of California, San Francisco
- University of Florida Health
- University of Pennsylvania Health System
- University of Texas MD Anderson Cancer Center
- University of Utah Health
- Yale New Haven Health System
NIH Institutes Providing Oversight: National Institute on Aging (NIA)
Program Official: Sekai Chideya, MD, MPH (NCCIH)
Project Scientist: Basil Eldadah, MD, MPH (National Institute on Aging [NIA])
ClinicalTrials.gov Identifier: NCT03424109
Trial Status: Follow Up
Trial Summary
Emergency medicine developed as a specialty to treat the acutely ill and injured, but increasingly cares for older adults with multiple comorbid conditions. An Emergency Department (ED) visit is a sentinel event for older adults, often signifying a breakdown in care coordination and worsening clinical and functional status. Half of Americans 65 years and older are seen in the ED in the last month of life, and three-quarters visit the ED in the six months before death. Meanwhile, the number and rate of admissions to the Intensive Care Unit (ICU) by emergency providers have been increasing, especially among older adults. Three-quarters of older adults with serious illness have thought about end-of-life care, and only 12% desire life-prolonging care. Emergency providers impact a patient’s clinical trajectory by balancing the potential harms and benefits of hospitalization and connecting seriously ill, older adults with outpatient services. Until recently, little attention has been paid to aligning care plans with patient goals for older adults in the ED. To address this gap in the delivery of goal-directed emergency care of seriously ill, older adults, our team conducted a randomized controlled trial of ED-initiated palliative care consultation in advanced cancer that showed improvement in quality of life at 12 weeks. We also showed in a Center for Medicare and Medicaid Innovation project that ED-based primary palliative care innovations reduced the percentage of geriatric ED admissions to the ICU from 2.3% to 0.9% through screening for high-risk older adults, early referral to palliative care and hospice, and emergency provider training and education in palliative care principles. Whether this approach will be feasible and effective in EDs with great heterogeneity in resources is unknown. We will tailor ”Primary Palliative Care for Emergency Medicine” (PRIM-ER) for implementation in a diverse group of 35 EDs that vary in specialty geriatric and palliative care capacity, geographic region, payer mix, and demographics. This proposal builds upon existing research partnerships to implement and evaluate PRIM-ER on ED disposition, healthcare utilization, and survival in older adults with serious, life-limiting illness. Our hypothesis is that older adult visitors with serious, life-limiting illness who are cared for by providers with primary palliative care skills will be less likely to be admitted to an inpatient setting, more likely to be discharged home or to a palliative care service, and will have higher home health and hospice use, fewer inpatient days and ICU admissions at six months, and longer survival than those seen prior to implementation. We propose a pragmatic, cluster-randomized stepped wedge design to test the effectiveness of PRIM-ER in 35 EDs. PRIM-ER includes: 1) evidence-based, multidisciplinary primary palliative care education, 2) simulation-based workshops on communication in serious illness, 3) clinical decision support, and 4) provider audit and feedback. The specific aims are divided into a: 1) UG3 Phase, in which we will tailor the protocols to a diverse ED context and pilot test the intervention at two sites; and a 2) UH3 Phase in which we will test the intervention in a stepped wedge design in 33 EDs. As of 12/6/21, all 33 enrolled UH3 sites have successfully completed the PRIM-ER intervention.
Data and Resource Sharing
- PRIM-ER-2019-UH3 Follow-up
PRIM-ER-Ethics and Regulatory UH3 Follow-up
- PRIM-ER Ethics and Regulatory Discussion
PRIM-ER Ethics and Regulatory Discussion
Featured Interviews
Dr. Grudzen discusses PRIM-ER, a NIH Collaboratory Trial that will implement primary palliative care in emergency medicine across a diverse group of Emergency Departments.
News and Interviews
- News_In PRIM-ER Qualitative Study, EM Talk Program Improved Serious Illness Conversation Skills
February 26, 2024: In PRIM-ER Qualitative Study, EM Talk Program Improved Serious Illness Conversation Skills
- News_A Year of New Insights From the NIH Pragmatic Trials Collaboratory
December 12, 2023: A Year of New Insights From the NIH Pragmatic Trials Collaboratory
- News_Wealth of New Insights From the NIH Pragmatic Trials Collaboratory
December 13, 2022: In Our Tenth Year, a Wealth of New Insights From the NIH Pragmatic Trials Collaboratory
- News_Pragmatic Trials in Emergency Medicine
July 18, 2022: New Article Offers Recommendations for Pragmatic Trials in Emergency Medicine
- News_A Year of New Insights From the NIH Collaboratory
December 14, 2021: A Year of New Insights From the NIH Collaboratory
- News_A Year of Results and New Insights From the NIH Collaboratory
December 15, 2020: A Year of Results and New Insights From the NIH Collaboratory
- News_PRIM-ER_Implementation
November 2, 2020: PRIM-ER Pilot Study Identifies Keys to Implementation Success
- News_Chapter in the Living Textbook Shares Best Practices for Clinical Decision Support in Pragmatic Trials
June 1, 2020: New Chapter in the Living Textbook Shares Best Practices for Clinical Decision Support in Pragmatic Trials
- News_PRIM-ER Gains Approval to Proceed to Implementation Phase
July 15, 2019: PRIM-ER Gains Approval to Proceed to Implementation Phase: An Interview With Dr. Corita Grudzen
- News_Spotlight on a New Demonstration Project_PRIM-ER
September 4, 2018: Spotlight on a New NIH Collaboratory Trial: PRIM-ER
Publications
- Adeyemi et al BMC Palliat Care 2024
Serious illness communication skills training for emergency physicians and advanced practice providers: a multi-method assessment of the reach and effectiveness of the intervention
- Adeyemi et al J Emerg Nurs
Emergency nurses' perceived barriers and solutions to engaging patients with life-limiting illnesses in serious illness conversations: a United States multicenter mixed-method analysis
- Adeyemi et al J Palliat Med 2023
Emergency providers' knowledge and attitudes toward hospice and palliative care: a cross-sectional analysis across 35 emergency departments in the United States
- Tan et al Am J Hosp Palliat Care 2022
Leveraging emergency department information systems to address palliative care needs of ED patients during the COVID pandemic
- Hill et al Glob Adv Health Med 2022
Household income and older adult population predict number of integrative medicine providers around US hospitals: an environmental scan study
- Grudzen et al Emerg Cancer Care 2022
Palliative care models for patients living with advanced cancer: a narrative review for the emergency department clinician
- Hill et al PLoS One 2022
Emergency provider perspectives on facilitators and barriers to home and community services for older adults with serious life limiting illness: a qualitative study
- Gettel et al Acad Emerg Med 2022
Pragmatic clinical trial design in emergency medicine: study considerations and design types
- Adeyemi et al Am J Hosp Palliat Care 2022
Knowledge and attitudes toward hospice and palliative care: instrument validation among emergency providers
- Hill et al J Am Geriatr Soc 2022
Emergency and post-emergency care of older adults with Alzheimer's disease/Alzheimer's disease related dementias
- Rege et al J Pain Symptom Manage 2022
Arranging hospice care from the emergency department: a single center retrospective study
- Pyles et al J Pain Symptom Manage 2021
Locating advance care planning documents in the electronic health record during emergency care
- Richesson et al J Am Med Inform Assoc 2021
Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory
- Chung et al J Gen Intern Med 2020
Effectiveness and reach of the Primary Palliative Care for Emergency Medicine (PRIM-ER) Pilot Study: a qualitative analysis
- Living Textbook Chapter_Clinical Decision Support
Living Textbook Chapter: Clinical Decision Support
- Living Textbook Chapter_Which PCTs Should Have a DMC
Living Textbook Chapter: Which PCTs Should Have a DMC?
- Living Textbook_The Embedded Pragmatic Trials Ecosystem
Living Textbook: The Embedded Pragmatic Clinical Trial Ecosystem
- Hill et al Contemp Clin Trials Commun 2020
Primary Palliative Care for Emergency Medicine (PRIM-ER): applying form and function to a theory-based complex intervention
- Hill et all Am J Hosp Palliat Care 2020
Access to home and community health services for older adults with serious, life-limiting illness: a study protocol
- Living Textbook Chapter_Monitoring Intervention and Fidelity Adaptions
Living Textbook Chapter: Monitoring Intervention and Fidelity Adaptions: Intervention Adaptation Strategies and Examples
- Tan et al BMC Med Inform Decis Mak 2020
Design and implementation of a clinical decision support tool for Primary Palliative Care for Emergency Medicine (PRIM-ER)
- Grudzen et al BMJ Open 2019
PRIM-ER Study Design Paper
- PRIM-ER Study Snapshot
PRIM-ER Study Snapshot
Presentations
- SC-Mtg-2024-Day2-Marsolo
Data Extraction and Quality Challenges/ Lessons Learned
- SC-Mtg-2024-Day2-Bosworth
Planning Effectively for Posttrial Activities
- PopHealthResSem_MSK_CRG_111222
The Palliation of Emergency Medicine
- Presentation PRIM-ER 2022 Regina Kaur
Palliative Care in Emergency Medicine
- Gettel - SAEM22
Pragmatic clinical trial design: experience, advice, and key decision points to consider
- Environmental Scan Poster Presentation AcademyHealth 2021
Environmental Scan of Emergency Department Referral Services for End-of-Life Care
- A. Schmucker AGS Presentation Slides
Care Trajectories of Older Adults with Alzheimer Disease in the Emergency Setting
- SAEM_EDPC_Didactic05032021_Tan
Palliative Care During COVID: Innovations in Care Delivery
- The Palliation of Emergency Medicine_Grudzen
The Palliation of Emergency Medicine
- Audit and Feedback Poster_AAHPM2023
The Use of Audit and Feedback in Implementing a Clinical Decision Support Tool Identifying Patients with Life-Limiting Illness in the Emergency Department
- PRIM-ER ELNEC poster_Adeyemi
Emergency Nurses’ Perceived Barriers and Solutions to Engaging Patients with Life-Limiting Illnesses in Serious Illness Conversations: A U.S. Multicenter Mixed-Method Analysis
- PRIM-ER HCSRN_ED identification presentation_2023-02-23
Strategies and Challenges Identifying Emergency Departments within Centers for Medicare & Medicaid Services Data Warehouse
- AcademyHealth -Adeyemi 06Jun2022
Hospice Referral Proneness Scale: Instrument Validation among Emergency Providers
- saem presentation_baseline data_v3_seun 12May2022
Emergency Provider’s Knowledge, and Attitudes Toward Palliative Care
- SC-Mtg-2023-Day1-Grudzen-PRIM-ER
Corita Grudzen Presentation at 2023 Steering Committee Meeting
- SC-Mtg-2023-Day1-Grudzen
Corita Grudzen Panel Presentation at 2023 Steering Committee Meeting
- AcademyHealth’s 2022 Dissemination and Implementation Science Meeting_Adeyemi
Serious Illness Communication Skills Training For Emergency Physicians and Advanced Practice Providers: A Multi Method Assessment of the Reach And Effectiveness of the Intervention
- GR-Video-01-21-22
Primary Palliative Care for Emergency Medicine (GR Video 2022)
- GR-Slides-01-21-22
Primary Palliative Care for Emergency Medicine (GR Slides 2022)
- Access to Home and Community Health Services (APHA 2020)
Access to Home and Community Health Services (APHA 2020)
- Presentation_PRIM-ER_DI_2019_c
Adoption of PRIM-ER: A Mixed-Methods Study Using RE-AIM (D&I 2019)
- PRIM-ER_2019-12-12
Adoption of Primary Palliative Care For Emergency Medicine (PRIM-ER) - A Mixed-Methods Study Using RE-AIM
- Abstract_PRIM-ER_DI_2019_c
Factors That Contribute to Successful Adoption of PRIM-ER: A Mixed-Methods Study Using RE-AIM (D&I 2019)
- Presentation_PRIM-ER_UGM_2019_c
Design and Implementation of a Clinical Decision Support Tool for PRIM-ER (Epic 2019)
- PRIM-ER_2019-08-26
Palliative Care Clinical Decision Support Tool
- SC-2019-UG3-PRIM-ER
UG3 Updates-PRIM-ER
- GR-Video-11-16-18
Primary Palliative Care for Emergency Medicine (PRIM-ER) (GR Video 2018)
- GR-Slides-11-16-18
Primary Palliative Care for Emergency Medicine (PRIM-ER) (GR Slides 2018)
- 9.-Grudzen_5min_FINAL
Primary Palliative Care for Emergency Medicine (PRIM-ER) Overview (brief)
- 15.-Grudzen_15min_FINAL
Primary Palliative Care for Emergency Medicine (PRIM-ER) Overview