Predictors of Documented Goals-of-Care Discussion for Hospitalized Patients With Chronic Illness
Goals-of-care discussions are important for patient-centered care among hospitalized patients with serious illness. However, there are little data on the occurrence, predictors, and timing of these discussions. To examine the occurrence, predictors, and timing of electronic health record (EHR)-docum...
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| Veröffentlicht in: | Journal of pain and symptom management Jg. 65; H. 3; S. 233 - 241 |
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| Sprache: | Englisch |
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Elsevier Inc
01.03.2023
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| Abstract | Goals-of-care discussions are important for patient-centered care among hospitalized patients with serious illness. However, there are little data on the occurrence, predictors, and timing of these discussions.
To examine the occurrence, predictors, and timing of electronic health record (EHR)-documented goals-of-care discussions for hospitalized patients.
This retrospective cohort study used natural language processing (NLP) to examine EHR-documented goals-of-care discussions for adults with chronic life-limiting illness or age ≥80 hospitalized 2015-2019. The primary outcome was NLP-identified documentation of a goals-of-care discussion during the index hospitalization. We used multivariable logistic regression to evaluate associations with baseline characteristics.
Of 16,262 consecutive, eligible patients without missing data, 5,918 (36.4%) had a documented goals-of-care discussion during hospitalization; approximately 57% of these discussions occurred within 24 hours of admission. In multivariable analysis, documented goals-of-care discussions were more common for women (OR=1.26, 95%CI 1.18-1.36), older patients (OR=1.04 per year, 95%CI 1.03-1.04), and patients with more comorbidities (OR=1.11 per Deyo-Charlson point, 95%CI 1.10-1.13), cancer (OR=1.88, 95%CI 1.72-2.06), dementia (OR=2.60, 95%CI 2.29-2.94), higher acute illness severity (OR=1.12 per National Early Warning Score point, 95%CI 1.11-1.14), or prior advance care planning documents (OR=1.18, 95%CI 1.08-1.30). Documentation of these discussions was less common for racially or ethnically minoritized patients (OR=0.823, 95%CI 0.75-0.90).
Among hospitalized patients with serious illness, documented goals-of-care discussions identified by NLP were more common among patients with older age and increased burden of acute or chronic illness, and less common among racially or ethnically minoritized patients. This suggests important disparities in goals-of-care discussions. |
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| AbstractList | Goals-of-care discussions are important for patient-centered care among hospitalized patients with serious illness. However, there are little data on the occurrence, predictors, and timing of these discussions.
To examine the occurrence, predictors, and timing of electronic health record (EHR)-documented goals-of-care discussions for hospitalized patients.
This retrospective cohort study used natural language processing (NLP) to examine EHR-documented goals-of-care discussions for adults with chronic life-limiting illness or age ≥80 hospitalized 2015-2019. The primary outcome was NLP-identified documentation of a goals-of-care discussion during the index hospitalization. We used multivariable logistic regression to evaluate associations with baseline characteristics.
Of 16,262 consecutive, eligible patients without missing data, 5,918 (36.4%) had a documented goals-of-care discussion during hospitalization; approximately 57% of these discussions occurred within 24 hours of admission. In multivariable analysis, documented goals-of-care discussions were more common for women (OR=1.26, 95%CI 1.18-1.36), older patients (OR=1.04 per year, 95%CI 1.03-1.04), and patients with more comorbidities (OR=1.11 per Deyo-Charlson point, 95%CI 1.10-1.13), cancer (OR=1.88, 95%CI 1.72-2.06), dementia (OR=2.60, 95%CI 2.29-2.94), higher acute illness severity (OR=1.12 per National Early Warning Score point, 95%CI 1.11-1.14), or prior advance care planning documents (OR=1.18, 95%CI 1.08-1.30). Documentation of these discussions was less common for racially or ethnically minoritized patients (OR=0.823, 95%CI 0.75-0.90).
Among hospitalized patients with serious illness, documented goals-of-care discussions identified by NLP were more common among patients with older age and increased burden of acute or chronic illness, and less common among racially or ethnically minoritized patients. This suggests important disparities in goals-of-care discussions. AbstractContextGoals-of-care discussions are important for patient-centered care among hospitalized patients with serious illness. However, there are little data on the occurrence, predictors, and timing of these discussions. ObjectivesTo examine the occurrence, predictors, and timing of electronic health record (EHR)-documented goals-of-care discussions for hospitalized patients. MethodsThis retrospective cohort study used natural language processing (NLP) to examine EHR-documented goals-of-care discussions for adults with chronic life-limiting illness or age ≥80 hospitalized 2015-2019. The primary outcome was NLP-identified documentation of a goals-of-care discussion during the index hospitalization. We used multivariable logistic regression to evaluate associations with baseline characteristics. ResultsOf 16,262 consecutive, eligible patients without missing data, 5,918 (36.4%) had a documented goals-of-care discussion during hospitalization; approximately 57% of these discussions occurred within 24 hours of admission. In multivariable analysis, documented goals-of-care discussions were more common for women (OR=1.26, 95%CI 1.18-1.36), older patients (OR=1.04 per year, 95%CI 1.03-1.04), and patients with more comorbidities (OR=1.11 per Deyo-Charlson point, 95%CI 1.10-1.13), cancer (OR=1.88, 95%CI 1.72-2.06), dementia (OR=2.60, 95%CI 2.29-2.94), higher acute illness severity (OR=1.12 per National Early Warning Score point, 95%CI 1.11-1.14), or prior advance care planning documents (OR=1.18, 95%CI 1.08-1.30). Documentation of these discussions was less common for racially or ethnically minoritized patients (OR=0.823, 95%CI 0.75-0.90). ConclusionAmong hospitalized patients with serious illness, documented goals-of-care discussions identified by NLP were more common among patients with older age and increased burden of acute or chronic illness, and less common among racially or ethnically minoritized patients. This suggests important disparities in goals-of-care discussions. Goals-of-care discussions are important for patient-centered care among hospitalized patients with serious illness. However, there are little data on the occurrence, predictors, and timing of these discussions.CONTEXTGoals-of-care discussions are important for patient-centered care among hospitalized patients with serious illness. However, there are little data on the occurrence, predictors, and timing of these discussions.To examine the occurrence, predictors, and timing of electronic health record (EHR)-documented goals-of-care discussions for hospitalized patients.OBJECTIVESTo examine the occurrence, predictors, and timing of electronic health record (EHR)-documented goals-of-care discussions for hospitalized patients.This retrospective cohort study used natural language processing (NLP) to examine EHR-documented goals-of-care discussions for adults with chronic life-limiting illness or age ≥80 hospitalized 2015-2019. The primary outcome was NLP-identified documentation of a goals-of-care discussion during the index hospitalization. We used multivariable logistic regression to evaluate associations with baseline characteristics.METHODSThis retrospective cohort study used natural language processing (NLP) to examine EHR-documented goals-of-care discussions for adults with chronic life-limiting illness or age ≥80 hospitalized 2015-2019. The primary outcome was NLP-identified documentation of a goals-of-care discussion during the index hospitalization. We used multivariable logistic regression to evaluate associations with baseline characteristics.Of 16,262 consecutive, eligible patients without missing data, 5,918 (36.4%) had a documented goals-of-care discussion during hospitalization; approximately 57% of these discussions occurred within 24 hours of admission. In multivariable analysis, documented goals-of-care discussions were more common for women (OR=1.26, 95%CI 1.18-1.36), older patients (OR=1.04 per year, 95%CI 1.03-1.04), and patients with more comorbidities (OR=1.11 per Deyo-Charlson point, 95%CI 1.10-1.13), cancer (OR=1.88, 95%CI 1.72-2.06), dementia (OR=2.60, 95%CI 2.29-2.94), higher acute illness severity (OR=1.12 per National Early Warning Score point, 95%CI 1.11-1.14), or prior advance care planning documents (OR=1.18, 95%CI 1.08-1.30). Documentation of these discussions was less common for racially or ethnically minoritized patients (OR=0.823, 95%CI 0.75-0.90).RESULTSOf 16,262 consecutive, eligible patients without missing data, 5,918 (36.4%) had a documented goals-of-care discussion during hospitalization; approximately 57% of these discussions occurred within 24 hours of admission. In multivariable analysis, documented goals-of-care discussions were more common for women (OR=1.26, 95%CI 1.18-1.36), older patients (OR=1.04 per year, 95%CI 1.03-1.04), and patients with more comorbidities (OR=1.11 per Deyo-Charlson point, 95%CI 1.10-1.13), cancer (OR=1.88, 95%CI 1.72-2.06), dementia (OR=2.60, 95%CI 2.29-2.94), higher acute illness severity (OR=1.12 per National Early Warning Score point, 95%CI 1.11-1.14), or prior advance care planning documents (OR=1.18, 95%CI 1.08-1.30). Documentation of these discussions was less common for racially or ethnically minoritized patients (OR=0.823, 95%CI 0.75-0.90).Among hospitalized patients with serious illness, documented goals-of-care discussions identified by NLP were more common among patients with older age and increased burden of acute or chronic illness, and less common among racially or ethnically minoritized patients. This suggests important disparities in goals-of-care discussions.CONCLUSIONAmong hospitalized patients with serious illness, documented goals-of-care discussions identified by NLP were more common among patients with older age and increased burden of acute or chronic illness, and less common among racially or ethnically minoritized patients. This suggests important disparities in goals-of-care discussions. |
| Author | Engelberg, Ruth A. Curtis, J. Randall Uyeda, Alison M. Sibley, James Cohen, Trevor Torrence, Janaki Lober, William B. Lee, Robert Y. Pollack, Lauren R. Kross, Erin K. Brumback, Lyndia C. Paul, Sudiptho R. Downey, Lois |
| AuthorAffiliation | 2 Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA 4 Department of Biostatistics, University of Washington, Seattle, WA 6 Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA 3 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA 5 Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 1 Department of Medicine, University of Washington, Seattle, WA |
| AuthorAffiliation_xml | – name: 6 Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA – name: 2 Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA – name: 5 Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA – name: 1 Department of Medicine, University of Washington, Seattle, WA – name: 3 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA – name: 4 Department of Biostatistics, University of Washington, Seattle, WA |
| Author_xml | – sequence: 1 givenname: Alison M. surname: Uyeda fullname: Uyeda, Alison M. organization: Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 2 givenname: Robert Y. orcidid: 0000-0001-5535-287X surname: Lee fullname: Lee, Robert Y. organization: Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 3 givenname: Lauren R. orcidid: 0000-0002-5186-5886 surname: Pollack fullname: Pollack, Lauren R. organization: Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 4 givenname: Sudiptho R. orcidid: 0000-0001-9896-0568 surname: Paul fullname: Paul, Sudiptho R. organization: Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 5 givenname: Lois orcidid: 0000-0003-3402-0133 surname: Downey fullname: Downey, Lois organization: Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 6 givenname: Lyndia C. surname: Brumback fullname: Brumback, Lyndia C. organization: Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 7 givenname: Ruth A. orcidid: 0000-0003-4099-185X surname: Engelberg fullname: Engelberg, Ruth A. organization: Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 8 givenname: James surname: Sibley fullname: Sibley, James organization: Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 9 givenname: William B. surname: Lober fullname: Lober, William B. organization: Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 10 givenname: Trevor surname: Cohen fullname: Cohen, Trevor organization: Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 11 givenname: Janaki surname: Torrence fullname: Torrence, Janaki organization: Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 12 givenname: Erin K. orcidid: 0000-0002-8206-3050 surname: Kross fullname: Kross, Erin K. organization: Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA – sequence: 13 givenname: J. Randall orcidid: 0000-0001-9529-845X surname: Curtis fullname: Curtis, J. Randall email: jrc@u.washington.edu organization: Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA |
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| SubjectTerms | Adult Advance Care Planning Anesthesia Chronic Disease Ethnicity Female Goals Goals-of-care discussions Humans Pain Medicine Palliative care Race Retrospective Studies Serious illness Terminal Care |
| Title | Predictors of Documented Goals-of-Care Discussion for Hospitalized Patients With Chronic Illness |
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