Cost-related Outcomes Associated with Documented Goals of Care Conversations.

IF 3.5 2区 医学 Q2 CLINICAL NEUROLOGY
Gina M Piscitello, Robert M Arnold, Jane Schell
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引用次数: 0

Abstract

Context: There is limited understanding about how documented goals of care conversations (GOCC) are associated with cost-related outcomes for hospitalized patients.

Objective: To primarily assess the association of documented GOCC with specialty palliative consults (SPC) and hospital cost-related outcomes.

Methods: This multihospital, cross-sectional study, which used propensity-score matching, assessed adult patients hospitalized between 2022-2024 at four hospitals. We used multivariable logistic and linear regression models to identify outcomes associated with documented GOCC.

Results: Of 267,375 patients with median age 61 years, 19,186 had a documented GOCC and 12,300 had a SPC during hospital admission. In the propensity-score matched cohort (n=24,600), documented GOCC with SPC were associated with decreased odds of in-hospital death (aOR 0.15, 95% CI 0.12-0.18), thirty-day readmission (aOR 0.68, 95% CI 0.57-0.82) and lower hospital length of stay (adjusted log-linear coefficient [β] -0.07, 95% CI -0.14- -0.01). They were also associated with lower total direct hospital costs for patients surviving hospital admission (β -0.18, 95% CI -0.26- -0.11), admitted to an ICU (β -0.13, 95% CI -0.23- -0.03) or with GOCC documented within 48 hours of admission (β -0.28, 95% CI -0.37- -0.19). In contrast, documented GOCC overall with or without SPC were associated with increased odds of in-hospital death (aOR 8.77, 95% CI 7.44-10.35, p<0.0001) and higher hospital length of stay (β 0.25, 95% CI 0.19-0.31, p<0.0001) and total direct costs (β 0.18, 95% CI 0.12-0.24, p<0.0001).

Conclusion: Early documented GOCC with SPC were associated with lower cost-related outcomes and may contribute to hospital cost-related savings.

与记录的护理对话目标相关的成本相关结果。
背景:对于住院患者的医疗谈话记录目标(GOCC)如何与费用相关的结果相关联,了解有限。目的:初步评估记录的GOCC与专业姑息治疗(SPC)和医院费用相关结果的关系。方法:这项多医院横断面研究采用倾向评分匹配,评估了四家医院2022-2024年间住院的成年患者。我们使用多变量逻辑和线性回归模型来确定与文献记载的GOCC相关的结果。结果:在267,375例中位年龄61岁的患者中,19,186例在住院期间有记录的GOCC, 12,300例有SPC。在倾向评分匹配的队列中(n=24,600),记录的GOCC合并SPC与院内死亡(aOR 0.15, 95% CI 0.12-0.18)、30天再入院(aOR 0.68, 95% CI 0.57-0.82)和住院时间缩短相关(校正对数线性系数[β] -0.07, 95% CI -0.14- -0.01)。它们还与住院存活(β -0.18, 95% CI -0.26- 0.11)、入住ICU (β -0.13, 95% CI -0.23- -0.03)或入院48小时内记录的GOCC (β -0.28, 95% CI -0.37- -0.19)的患者直接住院总费用较低相关。相比之下,无论有无SPC,记录的GOCC总体上与院内死亡的几率增加相关(aOR 8.77, 95% CI 7.44-10.35)。结论:早期记录的GOCC合并SPC与较低的成本相关结果相关,并可能有助于医院成本相关的节省。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.90
自引率
6.40%
发文量
821
审稿时长
26 days
期刊介绍: The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.
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