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- Title
The Association of Standardized Documentation of Serious Illness Conversations With Healthcare Utilization in Hospitalized Patients: A Propensity Score Matched Cohort Analysis.
- Authors
Serna, Myrna K.; Yoon, Catherine; Fiskio, Julie; Lakin, Joshua R.; Schnipper, Jeffrey L.; Dalal, Anuj K.
- Abstract
Background: Serious Illness Conversations (SICs) conducted during hospitalization can lead to meaningful patient participation in the decision-making process affecting medical management. The aim of this study is to determine if standardized documentation of a SIC within an institutionally approved EHR module during hospitalization is associated with palliative care consultation, change in code status, hospice enrollment prior to discharge, and 90-day readmissions. Methods: We conducted retrospective analyses of hospital encounters of general medicine patients at a community teaching hospital affiliated with an academic medical center from October 2018 to August 2019. Encounters with standardized documentation of a SIC were identified and matched by propensity score to control encounters without a SIC in a ratio of 1:3. We used multivariable, paired logistic regression and Cox proportional-hazards modeling to assess key outcomes. Results: Of 6853 encounters (5143 patients), 59 (.86%) encounters (59 patients) had standardized documentation of a SIC, and 58 (.85%) were matched to 167 control encounters (167 patients). Encounters with standardized documentation of a SIC had greater odds of palliative care consultation (odds ratio [OR] 60.10, 95% confidence interval [CI] 12.45-290.08, P <.01), a documented code status change (OR 8.04, 95% CI 1.54-42.05, P =.01), and discharge with hospice services (OR 35.07, 95% CI 5.80-212.08, P <.01) compared to matched controls. There was no significant association with 90-day readmissions (adjusted hazard ratio [HR].88, standard error [SE].37, P =.73). Conclusions: Standardized documentation of a SIC during hospitalization is associated with palliative care consultation, change in code status, and hospice enrollment.
- Subjects
UNITED States; DOCUMENTATION standards; MORTALITY risk factors; RISK assessment; CONVERSATION; PALLIATIVE treatment; ACADEMIC medical centers; RESEARCH funding; MEDICAL care; HOSPITAL care; LOGISTIC regression analysis; PROBABILITY theory; PATIENT readmissions; FISHER exact test; CATASTROPHIC illness; RETROSPECTIVE studies; MULTIVARIATE analysis; DISCHARGE planning; DESCRIPTIVE statistics; LONGITUDINAL method; ODDS ratio; KAPLAN-Meier estimator; ELECTRONIC health records; COMPARATIVE studies; CONFIDENCE intervals; PATIENT participation; HOSPICE care; MEDICAL referrals; COMORBIDITY; PROPORTIONAL hazards models
- Publication
American Journal of Hospice & Palliative Medicine, 2024, Vol 41, Issue 5, p479
- ISSN
1049-9091
- Publication type
Article
- DOI
10.1177/10499091231186818