Association between GCD at enrolment and health care resource use during hospitalization
| Outcome | Unadjusted rate ratio (95% CI) | Adjusted rate ratio (95% CI) |
|---|---|---|
| Continuous | ||
| All days LOS* | ||
| Resuscitative care | Ref. | Ref. |
| Medical care | 1.64 (1.26–2.13) | 1.42 (1.10–1.83) |
| Comfort care | 1.73 (0.92–3.26) | 1.26 (0.68–2.36) |
| No GCD | 0.75 (0.44–1.27) | 0.76 (0.45–1.27) |
| Resource Intensity Weight† | ||
| Resuscitative care | Ref. | Ref. |
| Medical care | 1.20 (1.07–1.34) | 1.14 (1.02–1.28) |
| Comfort care | 1.55 (1.19–2.03) | 1.13 (0.87–1.48) |
| No GCD | 1.00 (0.80–1.24) | 0.99 (0.80–1.23) |
| Dichotomous‡ | Unadjusted relative risk (95% CI) | Adjusted relative risk (95% CI) |
| Inpatient palliative care referral, yes | ||
| Resuscitative care | Ref. | Ref. |
| Medical care | 3.88 (1.96–7.7) | 3.58 (1.75–7.33) |
| Comfort care | 17.63 (9.21–34.01) | 9.32 (4.32–20.08) |
| No GCD§ | – | – |
| Flagged intervention, any | ||
| Resuscitative care | Ref. | Ref. |
| Medical care | 0.98 (0.92–1.04) | 0.98 (0.48–2.02) |
| Comfort care | 1.11 (0.95–1.31) | 1.06 (0.49–2.28) |
| No GCD | 0.91 (0.81–1.01) | 0.90 (0.39–2.07) |
Note: CI = confidence interval, GCD = Goals of Care Designation, LOS = length of stay, Ref. = reference category.
↵* Truncated negative binomial regression adjusted for age at enrolment, sex, race and ethnicity (white v. other), Clinical Frailty Scale score (well, mildly frail, severely frail), weighted Charlson Comorbidity Index score (low, moderate–high) and city. Truncated at 2 given patients were ineligible during the first 48 hours of an admission.
↵† γ-log link regression adjusted for age at enrolment, sex, race and ethnicity (white v. other), Clinical Frailty Scale score (well, mildly frail, severely frail), weighted Charlson Comorbidity Index score (low, moderate–high) and city.
↵‡ Modified Poisson regression model adjusted for age at enrolment, sex, race and ethnicity (white v. other), Clinical Frailty Scale score (well, mildly frail, severely frail), weighted Charlson Comorbidity Index score (low, moderate–high) and city.
↵§ Had no inpatient palliative care referral, so omitted from analysis.