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

Neetu Mahendraker; Esmeralda Gutierrez-Asis; Seho Park; Linda S. Williams; Titus Schleyer; Elizabeth E. Umberfield

doi:10.1055/s-0044-1788652

ACI Open, Inhaltsverzeichnis

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

¹Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States

²Indiana University Health Physicians Inc., Indianapolis, Indiana, United States

,

Esmeralda Gutierrez-Asis

¹Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States

²Indiana University Health Physicians Inc., Indianapolis, Indiana, United States

,

Seho Park

³Regenstrief Institute, Indianapolis, Indiana, United States

⁴Department of Industrial and Data Engineering, Hongik University, Seoul, South Korea

,

Linda S. Williams

³Regenstrief Institute, Indianapolis, Indiana, United States

⁵Roudebush VA Medical Center Health Services Research and Development, Indianapolis, Indiana, United States

⁶Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, United States

,

Titus Schleyer^*

¹Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States

³Regenstrief Institute, Indianapolis, Indiana, United States

,

Elizabeth E. Umberfield^*

⁷Department of Nursing, Division of Nursing Research, Mayo Clinic, Rochester, Minnesota, United States

⁸Department of Artificial Intelligence & Informatics, Mayo Clinic, Rochester, Minnesota, United States

› Institutsangaben

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

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Referenzen

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