SHM Converge Scientific Abstract ePoster Gallery-Promoting Timely Goals of Care Discussions: Non-Randomized Observational Pilot Study.

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This non-randomized observational pilot study tested whether an electronic health record (EHR)-based mortality prediction model could help hospitalists identify seriously ill transferred patients who need timely goals of care discussions (GOCD).<br /><br />At Indiana University Health Academic Health Center, 42 high-risk patients in an intervention group and 42 historical controls were included. Patients met a 30-day inpatient mortality risk threshold of -2.19. On day 2 of hospitalization, hospitalists received an electronic prompt showing the model’s mortality risk estimate and were asked whether they agreed with the risk level and whether GOCD was needed.<br /><br />The main outcome was whether hospitalists recognized the need for timely GOCD. Secondary outcomes included GOCD completion within 72 hours, code status changes, ICU escalation, inpatient hospice length of stay, and discharge disposition.<br /><br />Results showed that hospitalists were significantly more likely to identify the need for GOCD in the intervention group than in controls (21.43% vs. 9.52%, p<0.0001). Risk stratification differed significantly between groups as well. While the study was too small to draw firm conclusions about secondary outcomes, those outcomes generally favored the intervention group. Among patients who died, the model’s mortality prediction was significantly associated with actual inpatient death, and patients above the risk threshold were more likely to die.<br /><br />The authors conclude that implementing an EHR-based mortality model to prompt hospitalists is feasible and may improve end-of-life care for transferred patients. Next steps include interviewing hospitalists to better understand their preferences and training them to improve GOCD quality and documentation.

Asset Subtitle

Neetu Mahendraker

Meta Tag

Author List Elizabeth E. Umberfield, Esmeralda Gutierrez-Asis, Linda Williams, Neetu Mahendraker, Seho Park, Titus Schleyer

Category Research

Concept Mortality Prediction Model

Concept Goals of Care Discussion

Concept Study Design

Concept Observational Pilot Study

Concept Mortality Risk Recognition

Distinguished Non-Finalist

Presenter Organization Indiana University

Presenting Author Neetu Mahendraker

Track Quality Improvement

Keywords

electronic health record

mortality prediction model

hospitalists

goals of care discussions

seriously ill patients

observational pilot study

inpatient mortality

risk stratification

end-of-life care

hospice

Mortality Prediction Model

Goals of Care Discussion

Study Design

Observational Pilot Study

Mortality Risk Recognition