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Table 1 Project outcomes and outcome measures for the InterACT study

From: A stepped-wedge randomised-controlled trial assessing the implementation, impact and costs of a prospective feedback loop to promote appropriate care and treatment for older patients in acute hospitals at the end of life: study protocol

Outcome label Outcome Outcome measure
Impact outcomes
 Primary outcome (Outcome 1) Proportion of patients with one or more Intensive Care Unit (ICU) admissions ICU admissions during the current hospital stay from the date first recorded as high-risk CriSTAL and SPICT-positive.
 Outcome 2 Length of hospital stay and discharge outcome Length of hospital stay, with the transition endpoints of ‘discharged alive’ and ‘death in hospital’, from the date first recorded as high-risk CriSTAL and SPICT-positive.
 Outcome 3 Time to hospital re-admission The time in days to re-admission to any Queensland public hospital for re-admissions within 12 weeks from the date of discharge.
 Outcome 4 Time to first documented indications of clinician-led care review discussion The time in days from the date first recorded as high-risk CriSTAL and SPICT-positive to documentation of a clinician-led care review activity. The type of care review activity (reduce/cease active treatment, increase comfort care, continue active treatment) and indications of family conflict will also be recorded.
 Outcome 5 Time to first care directive measure The time in days from the date first recorded as high-risk CriSTAL and SPICT-positive to documentation of any care directive (including discussion outcomes, advance care plan, statement of choices, acute resuscitation plan). The type of care directive will also be recorded.
 Outcome 6 Time to first palliative care referral The time in days to first documented palliative care referral from the date first recorded as high-risk CriSTAL and SPICT-positive during the current hospital stay.
 Outcome 7 Time to first medical emergency call The time in days to first medical emergency call during the current hospital stay.
Health care resource use and cost outcomes
 Outcome 8 Changes in admission/hospitalisation and treatment costs Costs of treatment will be taken from routinely collected information and will begin accumulating from the date first recorded as high-risk CriSTAL and SPICT positive. This ensures that treatment costs reflect only those costs that relate to care provided at the end-of-life phase. All costs will be stratified by the acute and palliative care phases so that any changes resulting from different treatment pathways can be identified.
 Outcome 9 Cost of implementing the prospective feedback loop intervention The cost of implementing the study intervention will be measured by the duration and unit costs of staff time associated with completing direct trial activities (including document review and clinical team feedback activities).
Process outcomes
 Extent and fidelity of intervention implementation, impact, and contextual barriers and enablers of the feedback loop intervention