Affiliations

Aurora Health Care Palliative Medicine Fellowship

Center for Urban Population Health

Aurora Research Institute

Aurora West Allis Medical Center

Presentation Notes

Poster presented at: Aurora Scientific Day; May 20, 2020; virtual webinar hosted in Milwaukee, WI.

Abstract

Background: Palliative interventions by nonpalliative health care providers such as hospitalists have proved to be beneficial to patients. A primary task of these providers is to hold goals of care (GOC) conversations with patients early during their hospital stay. This can help reserve the expertise of palliative care specialists for more complex patients. While a previous local evaluation focused on providers’ overall comfort in initiating GOC conversation before and after an intervention, no study has explored whether the intervention resulted in providers having more GOC conversations.

Purpose: To explore whether GOC training sessions increased hospitalists’ utilization of the GOC dotphrase generated by the Epic electronic health record; also, to evaluate if there was an improvement in the overall quality of GOC conversations held with patients upon admission.

Methods: Aurora Health Care hospitalists participated in training sessions covering GOC conversations during 2017–2018. We reviewed 200 history and physical notes (H&Ps) for 5 full-time hospitalists before and after training. H&Ps were reviewed only for patients who were ≥65 years of age and admitted directly to the intensive care unit. For each hospitalist, only the 20 most recent charts before and after the intervention were included. Documented GOC conversations were tabulated, including the use of the GOC dotphrase. Quality assessment was done by searching for goalconcordant keywords and their synonyms within these conversations. Basic descriptive statistics were used to describe the population. Chisquared tests and t-tests were used as appropriate to compare groups.

Results: Patient demographics of H&Ps reviewed were as follows: 95% White, 59% female, and mean age 79 years. Older patients (mean: 84 years) were more likely to have a GOC conversation (P<0.001). Although there was an increase in usage of the GOC dotphrase after training sessions (73% compared to 31%; P=<0.01), only 23% of patients had a GOC conversation. The overall quality of the GOC conversations both before and after the intervention remained essentially unchanged (17% vs 18%).

Conclusion: Half-day training sessions in conducting goals of care conversations were associated with an increased usage of the GOC dotphrase. Our next steps will be to broaden the scope of this study by not only retraining hospitalists but also including providers from other facilities in our analysis, thus increasing the number of analyzed patient history and physical notes.

Document Type

Article

PubMed ID

33163557

DOI

10.17294/2330-0698.1818

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