Pilot Program to Study Telehealth Value in Advance Care Planning

Two Massachusetts healthcare providers are taking part in a federally funded in study to determine how telehealth can be used to facilitate advance care planning for patients with life-threatening illnesses who are receiving home-based care.

Massachusetts General Hospital and Harvard Medical School are partnering with ACP decisions, a non-profit focused on advance care planning, and connected health company Clover Health Investments on the study, which is financed by a five-year grant from the National Institutes of Health.

“We expect this study will generate pivotal data to help us understand if scalable video technology can meaningfully improve end of life outcomes for the most vulnerable older adults who are rarely part of clinical trials,” Kumar Dharmarajan, chief scientific officer at New Jersey-based Clover Health and an adjunct assistant professor at the Yale School of Medicine, said in a press release.

Even before the coronavirus pandemic pushed care providers to shift as many services as possible from in-person to virtual care channels, some were exploring how telehealth could be used in palliative care, both to reduce the burden on patients and their families and to expand the reach of the limited number of palliative care providers.

“Care planning and care decisions are very personal and very relational,” Dr. Christopher P. Comfort, the Medical Director of New York City’s Calvary Hospital, said in a February 2019 interview with mHealthIntelligence. “But there really is not the manpower of palliative care specialists to provide those services face-to-face. There’s a wonderful opportunity here to … make this (process) better.”

The research project will be run through Clover Health’s In-Home Primary care program, and will involve some 500 Medicare patients with life-limiting illnesses and a prognosis of one year or less, recruited from 17 counties in New Jersey with substantial ethnic and racial diversity.

“The number of patients living with serious chronic illness and receiving home-based care through house call providers is increasing,” the study’s coordinators said in the press release. “Often, these patients lack exposure to specialty palliative care and receive education and counseling on advance care planning much too late. Healthcare systems are seeking scalable solutions that provide advance care planning services to more patients earlier in their disease course yet are constrained by the scarcity of palliative care clinicians and the lack of clinical programs outside the hospital setting.”

“This project has the potential to shift the paradigm of care for seriously ill patients by utilizing technology to inform their preferences for care and enhance patient-centered decision-making at the end of life,” Areej El-Jawahri, an oncologist at Boston-based Mass. General and co-principal investigator in the study, said in the press release.