{"title":"Cost-related Outcomes Associated with Documented Goals of Care Conversations.","authors":"Gina M Piscitello, Robert M Arnold, Jane Schell","doi":"10.1016/j.jpainsymman.2025.09.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Context: </strong>There is limited understanding about how documented goals of care conversations (GOCC) are associated with cost-related outcomes for hospitalized patients.</p><p><strong>Objective: </strong>To primarily assess the association of documented GOCC with specialty palliative consults (SPC) and hospital cost-related outcomes.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>Early documented GOCC with SPC were associated with lower cost-related outcomes and may contribute to hospital cost-related savings.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jpainsymman.2025.09.017","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
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.
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.