PT  - JOURNAL ARTICLE
AU  - Madalene A. Earp
AU  - Konrad Fassbender
AU  - Seema King
AU  - Maureen Douglas
AU  - Patricia Biondo
AU  - Amanda Brisebois
AU  - Sara N. Davison
AU  - Winnie Sia
AU  - Eric Wasylenko
AU  - LeAnn Esau
AU  - Jessica Simon
TI  - Association between Goals of Care Designation orders and health care resource use among seriously ill older adults in acute care: a multicentre prospective cohort study
AID  - 10.9778/cmajo.20210155
DP  - 2022 Oct 01
TA  - CMAJ Open
PG  - E945--E955
VI  - 10
IP  - 4
4099  - http://www.cmajopen.ca/content/10/4/E945.short
4100  - http://www.cmajopen.ca/content/10/4/E945.full
SO  - CMAJ2022 Oct 01; 10
AB  - Background The Goals of Care Designation (GCD) is a medical order used to communicate the focus of a patient’s care in Alberta, Canada. In this study, we aimed to determine the association between GCD type (resuscitative, medical or comfort) and resource use during hospitalization.Methods This was a prospective cohort study of newly hospitalized inpatients in Alberta conducted from January to September 2017. Participants were aged 55 years or older with chronic obstructive pulmonary disease, congestive heart failure, cirrhosis, cancer or renal failure; aged 55–79 years and their provider answered “no” to the “surprise question” (i.e., provider would not be surprised if the patient died in the next 6 months); or aged 80 years or older with any acute condition. The exposure of interest was GCD. The primary outcome was health care resource use during admission, measured by length of stay (LOS), intensive care unit hours, Resource Intensity Weights (RIWs), flagged interventions and palliative care referral. The secondary outcome was 30-day readmission. Adjusted regression analyses were performed (adjusted for age, sex, race and ethnicity, Clinical Frailty Scale score, comorbidities and city).Results We included 475 study participants. The median age was 83 (interquartile range 77–87) years, and 93.7% had a GCD at enrolment. Relative to patients with the resuscitative GCD type, patients with the medical GCD type had a longer LOS (1.42 times, 95% confidence interval [CI] 1.10–1.83) and a higher RIW (adjusted ratio 1.14, 95% CI 1.02–1.28). Patients with the comfort and medical GCD types had more palliative care referral (comfort GCD adjusted relative risk (RR) 9.32, 95% CI 4.32–20.08; medical GCD adjusted RR 3.58, 95% CI 1.75–7.33) but not flagged intervention use (comfort GCD adjusted RR 1.06, 95% CI 0.49–2.28; medical GCD adjusted RR 0.98, 95% CI 0.48–2.02) or 30-day readmission (comfort GCD adjusted RR 1.00, 95% CI 0.85–1.19; medical GCD adjusted RR 1.05, 95% CI 0.97–1.20).Interpretation Goals of Care Designation type early during admission was associated with LOS, RIW and palliative care referral. This suggests an alignment between health resource use and the focus of care communicated by each GCD.