Division of General Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
Am J Hosp Palliat Care. 2024 May;41(5):479-485. doi: 10.1177/10499091231186818. Epub 2023 Jun 29.
Serious Illness Conversations (SICs) conducted during hospitalization can lead to meaningful patient participation in the decision-making process affecting medical management. The aim of this study is to determine if standardized documentation of a SIC within an institutionally approved EHR module during hospitalization is associated with palliative care consultation, change in code status, hospice enrollment prior to discharge, and 90-day readmissions. We conducted retrospective analyses of hospital encounters of general medicine patients at a community teaching hospital affiliated with an academic medical center from October 2018 to August 2019. Encounters with standardized documentation of a SIC were identified and matched by propensity score to control encounters without a SIC in a ratio of 1:3. We used multivariable, paired logistic regression and Cox proportional-hazards modeling to assess key outcomes. Of 6853 encounters (5143 patients), 59 (.86%) encounters (59 patients) had standardized documentation of a SIC, and 58 (.85%) were matched to 167 control encounters (167 patients). Encounters with standardized documentation of a SIC had greater odds of palliative care consultation (odds ratio [OR] 60.10, 95% confidence interval [CI] 12.45-290.08, < .01), a documented code status change (OR 8.04, 95% CI 1.54-42.05, = .01), and discharge with hospice services (OR 35.07, 95% CI 5.80-212.08, < .01) compared to matched controls. There was no significant association with 90-day readmissions (adjusted hazard ratio [HR] .88, standard error [SE] .37, = .73). Standardized documentation of a SIC during hospitalization is associated with palliative care consultation, change in code status, and hospice enrollment.
住院期间进行严重疾病对话（SIC）可以导致患者有意义地参与影响医疗管理的决策过程。本研究的目的是确定在住院期间通过机构批准的电子病历（EHR）模块中标准化记录 SIC 是否与姑息治疗咨询、医嘱状态改变、出院前入组临终关怀以及 90 天再入院相关。我们对 2018 年 10 月至 2019 年 8 月期间在一所社区教学医院进行的普通内科患者的住院就诊进行了回顾性分析。确定了有 SIC 标准化记录的就诊，并通过倾向评分匹配无 SIC 的就诊，比例为 1:3。我们使用多变量、配对逻辑回归和 Cox 比例风险模型来评估关键结局。在 6853 次就诊（5143 名患者）中，有 59 次（8.6%）就诊（59 名患者）有 SIC 的标准化记录，其中 58 次（8.5%）与 167 次对照就诊（167 名患者）相匹配。有 SIC 标准化记录的就诊更有可能接受姑息治疗咨询（比值比[OR]60.10，95%置信区间[CI]12.45-290.08，<.01），医嘱状态改变（OR 8.04，95%CI 1.54-42.05，=.01），以及出院时接受临终关怀服务（OR 35.07，95%CI 5.80-212.08，<.01），与匹配的对照就诊相比。90 天再入院没有显著相关性（调整后的风险比[HR]0.88，标准误[SE]0.37，=.73）。住院期间 SIC 的标准化记录与姑息治疗咨询、医嘱状态改变和临终关怀入院相关。
