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CC BY 4.0 · ACI open 2024; 08(02): e69-e78
DOI: 10.1055/s-0044-1788652
Research Article

Using Electronic Health Record Mortality Data to Promote Goals-of-Care Discussions in Seriously Ill Transferred Patients: A Pilot Study

Neetu Mahendraker
1   Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
2   Indiana University Health Physicians Inc., Indianapolis, Indiana, United States
,
Esmeralda Gutierrez-Asis
1   Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
2   Indiana University Health Physicians Inc., Indianapolis, Indiana, United States
,
Seho Park
3   Regenstrief Institute, Indianapolis, Indiana, United States
4   Department of Industrial and Data Engineering, Hongik University, Seoul, South Korea
,
Linda S. Williams
3   Regenstrief Institute, Indianapolis, Indiana, United States
5   Roudebush VA Medical Center Health Services Research and Development, Indianapolis, Indiana, United States
6   Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, United States
,
Titus Schleyer   *
1   Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
3   Regenstrief Institute, Indianapolis, Indiana, United States
,
Elizabeth E. Umberfield   *
7   Department of Nursing, Division of Nursing Research, Mayo Clinic, Rochester, Minnesota, United States
8   Department of Artificial Intelligence & Informatics, Mayo Clinic, Rochester, Minnesota, United States
› Author Affiliations Funding This work was supported by Regenstrief Institute's Development of Indiana Learning Health Systems Initiative (LHSI) under award number AIM 002, Prop ID: 18-0425-3R. E.E.U. was supported by the National Library of Medicine of the National Institutes of Health under award number T15LM012502. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of Regenstrief Institute or the National Institutes of Health.
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Abstract

Background Mortality prediction data may aid in identifying seriously ill transferred patients at high risk of dying and facilitate early goals-of-care discussions (GOCD); however, this is rarely evaluated. We recently developed a model for predicting 30-day inpatient mortality, which may be useful for promoting early GOCD.

Objectives Our objectives were to examine the effects of sharing model-generated mortality risk with hospitalists by assessing (1) if hospitalists agreed with the mortality risk prediction, (2) if they planned to conduct GOCD or consult palliative care within 72 hours of transfer, and (3) if the communication alert affected GOCD timing and other clinical outcomes. We also aimed to measure the association between both the model-generated and hospitalists' stratified risk assessments with patient mortality.

Methods This was a nonrandomized quasi-experimental pilot study with a historical control group. On the second day of hospitalization, the model-generated risk was communicated to the hospitalists. Hospitalists were asked to answer questions via a HIPAA (Health Insurance Portability and Accountability Act)-compliant mobile communication system, and clinical outcomes were extracted via chart review.

Results Eighty-four patients (42 in the control and 42 in the intervention group) were included in this study. Hospitalists agreed that all patients in the intervention group were at risk for inpatient mortality. Hospitalists were more likely to indicate a plan to conduct GOCD in the intervention group (n = 9) compared with the control group (n = 4, p < 0.001). In this subset of patients, GOCD was completed within 72 hours in 78% of intervention patients (n = 7) as compared with 50% in the control group (n = 2). The greater absolute value of the model-generated mortality risk was significantly associated with deaths (p = 0.01), similar to the hospitalists' prediction of the mortality risk (p = 0.02).

Conclusion Communicating model-generated mortality risk to hospitalists is a promising approach to promote timely GOCD.

Keywords

goals-of-care discussions - inpatient mortality model - mortality risk stratification - clinical decision support - electronic health records

Protection of Human and Animal Subjects

This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the Indiana University Institutional Review Board.


Note

Poster presentation at Society of Hospital Medicine Annual Conference: March 2023.


* Dr. Schleyer and Dr. Umberfield are co-senior authors of this manuscript.




Publication History

Received: 11 May 2023

Accepted: 01 May 2024

Article published online:
24 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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