A24-07 From Documentation to Delivery: Assessing the Impact of Goals-of-care Discussions on Goal-concordant Care

Rationale Older patients commonly receive goal-discordant care during hospitalization, and quality of communication is known to be a modifiable factor. While inpatient goals-of-care discussions (GOCDs) can reduce unwanted healthcare utilization, there is a paucity of literature evaluating their impact on patient outcomes such as goal-concordant care. Further research is needed to understand whether inpatient GOCDs improve patient- and surrogate-centered outcomes, including goal-concordant care. Methods We evaluated the association between inpatient electronic health record (EHR)-documented GOCDs and patient- or surrogate-reported goal-concordant care. We conducted a secondary analysis of data from a randomized trial of a communication priming intervention in older, hospitalized patients with chronic, life-limiting illness. Patient participants were 55 years or older with at least one chronic, life-limiting illness, and were hospitalized at one of three hospitals in the UW Medicine system. EHR-documented GOCDs within 30 days after admission were identified using natural language processing, and goal-concordant care was defined as a binary outcome based on two items from patient or surrogate surveys distributed 4 to 6 weeks after admission. Participants with missing survey responses were excluded. Linear regression with robust standard errors was used to evaluate the association between the occurrence of an EHR-documented GOCD and patient- or surrogate-reported goal-concordant care. Results Among 617 patient participants in the parent trial, N = 403 had survey responses about goal-concordant care available; 83.1% of survey responses were patient-reported and 16.9% were surrogate-reported. Participants had a mean age of 72 years, 43.9% were female, 80.1% identified as White and non-Hispanic, 44.7% had a 4-year college degree or higher education, and 41.9% were married; 9.7% participants had a diagnosis of dementia, and 21.3% had a diagnosis of life-limiting cancer (Table 1). Ninety (22%) participants had an EHR-documented GOCD within 30 days of admission. The proportion of survey-reported goal-concordant care was higher among patient participants with a documented GOCD compared to those without GOCD (63.3% vs. 46.0%; risk difference 17.3%, 95%CI 5.8-28.8%, p = 0.003). Results were consistent after adjustment for age, gender, marital status, education level, site of hospitalization, severity of acute and chronic illness, dementia, and life-limiting cancer (risk difference 15.9%, 95%CI 3.6-28.1%, p = 0.01). Conclusion This study demonstrates an association between EHR-documented GOCDs and patient- or surrogate-reported goal-concordant care in hospitalized patients with chronic, life-limiting illness. Our findings provide important context for future studies investigating how GOCDs and specific domains of these discussions impact goal-concordant care and other patient- and surrogate-reported outcomes. This abstract is funded by: NIH/NIA: R01AG062441 (Kross PI); 5 T32HL125195-10