Implementing Goals of Care Notes in a Statewide Health System: A Quality Improvement Initiative - 28/12/24

Doi : 10.1016/j.amjmed.2024.11.029

Shilpee Sinha, MD, FACP, FAAHPM ^a,^b,^⁎ , Shannon Countryman, MBA-HM, RN, CHPN ^a, Ami Patel, MD ^a,^b, Chelsea Powell, RN, CHPN ^a, James E. Slaven, MS, MA ^c, Amber R. Comer, PhD, JD ^e,^f, Alexia M. Torke, MD, MS ^a,^b,^d
^a IUH Department of Palliative Care, Indiana University Health, Indianapolis, IN
^b Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN
^c Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
^d Indiana University Center for Ageing Research, Regenstreif Institute, Indianapolis, IN
^e Indiana University School of Health and Human Sciences, Indianapolis, IN
^f American Medical Association, Indianapolis, IN

^⁎Requests for reprints should be addressed to Shilpee Sinha, MD, FACP, FAAHPM, Palliative Care Services, Adult Academic Health Center, Indiana University Health, Department of Clinical Medicine, Indiana University School of Medicine, 1633 North Capitol Avenue, Indianapolis, IN 46202.Palliative Care ServicesAdult Academic Health CenterIndiana University HealthDepartment of Clinical MedicineIndiana University School of Medicine1633 North Capitol AvenueIndianapolisIN46202

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Saturday 28 December 2024

Abstract

Background

Goals of care (GOC) documentation for seriously ill patients is integral to patient-centered care but not standardized. Collaborative efforts within the health system to improve the frequency and documentation of GOC to communicate patient preferences and values are essential to ensure both quality of life and quality of death.

Measures

We created a standard GOC note type and location in the electronic medical record for a large, statewide health system in the Midwest. Utilization and note content for all unique GOC note types documented in the first year were reviewed. A framework of GOC topics including treatment plan, prognosis, patient preferences and values, and quality of life was used to review the note content. Demographic data and outcomes including death during the observation period and hospice enrollment were also collected.

Outcomes

In the first year, 934 GOC notes were documented. Palliative care (PC) clinicians addressed more GOC fields compared to other clinicians (70% vs 31%, P < .0001) and had earlier discussions (median 19 days before death vs 4 days, P < .0001). Hospice was discussed more by PC (50% vs 27%, P = .0001) and PC discussions were followed by higher hospice enrollments before death (50% vs 35% P = .0166).

Conclusions

We successfully implemented a standard electronic medical record location for GOC notes which improved GOC documentation across a state healthcare system and found variations and gaps in fields addressed by all clinicians as well as key differences between PC clinicians vs other clinicians.

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Keywords : Advance care planning, Goals of care, Patient-centered care

Esquema

	Funding: There is no funding for this project.
	Authorship: SS: Writing—review and editing, Writing—original draft, Supervision, Project administration, Methodology, Investigation, Data curation, Conceptualization; SC: Writing—original draft, Visualization, Project administration, Investigation, Data curation; AP: Writing—review and editing, Writing—original draft, Data curation; CP: Writing—original draft, Resources, Data curation; JES: Writing—review and editing, Writing—original draft, Methodology, Formal analysis; ARC: Writing—review and editing, Methodology, AMT: Writing—review and editing, Supervision, Methodology.
	Conflict of Interest: Dr Torke was supported by a midcareer investigator award from the National Institute on Aging (K24AG053794). She also has other grant support from the National Institute on Aging. Dr Torke is on the National Advisory Board for Transforming Chaplaincy. There are no other conflicts of interest for any other authors.