The Association of Standardized Documentation of Serious Illness Conversations With Healthcare Utilization in Hospitalized Patients: A Propensity Score Matched Cohort Analysis.
Am J Hosp Palliat Care
; 41(5): 479-485, 2024 May.
Article
em En
| MEDLINE
| ID: mdl-37385609
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 13. 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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Cuidados Paliativos
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Participação do Paciente
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article