Background One ACP aim is achieving goal concordant care. The Goals of Care Designation (GCD) is a medical order communicating the focus of a patient’s care in Alberta, Canada. GCDs are created to align patient values and beliefs with clinicians’ medical expertise in determining care goals. We sought the association between GCD type (resuscitative, medical or comfort) and in-hospital resource use.
Methods Prospective cohort study of newly hospitalized in-patients, ≥55 years with chronic obstructive pulmonary disease, heart failure, cirrhosis, cancer or kidney failure; prospected <6 month survival by a healthcare provider; or ≥80 years with any acute condition. The exposure of interest was GCD. The primary outcome was health 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. Regression analyses were adjusted for age, sex, race, frailty, and comorbidities.
Results Of 475 participants, median age 83 years (interquartile range 77–87), 93.7% had a GCD at enrolment. Relative to patients with resuscitative GCD, patients with medical GCD 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 comfort or medical GCD had a higher likelihood of 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). Last recorded GCD was highly associated with death and discharge location (p<0.001) but not 30-day readmission.
Conclusion GCD 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.
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