RT Journal Article
SR Electronic
T1 Association between Goals of Care Designation orders and health care resource use among seriously ill older adults in acute care: a multicentre prospective cohort study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E945
OP E955
DO 10.9778/cmajo.20210155
VO 10
IS 4
A1 Earp, Madalene A.
A1 Fassbender, Konrad
A1 King, Seema
A1 Douglas, Maureen
A1 Biondo, Patricia
A1 Brisebois, Amanda
A1 Davison, Sara N.
A1 Sia, Winnie
A1 Wasylenko, Eric
A1 Esau, LeAnn
A1 Simon, Jessica
YR 2022
UL http://www.cmajopen.ca/content/10/4/E945.abstract
AB Background The Goals of Care Designation (GCD) is a medical order used to communicate the focus of a patient’s care in Alberta, Canada. In this study, we aimed to determine the association between GCD type (resuscitative, medical or comfort) and resource use during hospitalization.Methods This was a prospective cohort study of newly hospitalized inpatients in Alberta conducted from January to September 2017. Participants were aged 55 years or older with chronic obstructive pulmonary disease, congestive heart failure, cirrhosis, cancer or renal failure; aged 55–79 years and their provider answered “no” to the “surprise question” (i.e., provider would not be surprised if the patient died in the next 6 months); or aged 80 years or older with any acute condition. The exposure of interest was GCD. The primary outcome was health care resource use during admission, measured by length of stay (LOS), intensive care unit hours, Resource Intensity Weights (RIWs), flagged interventions and palliative care referral. The secondary outcome was 30-day readmission. Adjusted regression analyses were performed (adjusted for age, sex, race and ethnicity, Clinical Frailty Scale score, comorbidities and city).Results We included 475 study participants. The median age was 83 (interquartile range 77–87) years, and 93.7% had a GCD at enrolment. Relative to patients with the resuscitative GCD type, patients with the medical GCD type had a longer LOS (1.42 times, 95% confidence interval [CI] 1.10–1.83) and a higher RIW (adjusted ratio 1.14, 95% CI 1.02–1.28). Patients with the comfort and medical GCD types had more palliative care referral (comfort GCD adjusted relative risk (RR) 9.32, 95% CI 4.32–20.08; medical GCD adjusted RR 3.58, 95% CI 1.75–7.33) but not flagged intervention use (comfort GCD adjusted RR 1.06, 95% CI 0.49–2.28; medical GCD adjusted RR 0.98, 95% CI 0.48–2.02) or 30-day readmission (comfort GCD adjusted RR 1.00, 95% CI 0.85–1.19; medical GCD adjusted RR 1.05, 95% CI 0.97–1.20).Interpretation Goals of Care Designation type early during admission was associated with LOS, RIW and palliative care referral. This suggests an alignment between health resource use and the focus of care communicated by each GCD.