Health care resource use during hospitalization, by GCD type
| Outcome | GCD type at enrolment | p value* | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Resuscitative care n = 177 | Medical care n = 248 | Comfort care n = 20 | No GCD n = 30 | ||||||
| Continuous | Median (IQR) | ||||||||
| All days LOS | 7 (5–12) | 9 (6–20) | 10 (6.8–16) | 6.5 (4.2–10) | < 0.001 | ||||
| Resource Intensity Weight | 1.0 (0.7–1.6) | 1.3 (0.8–2.5) | 1.5 (1.0–1.9) | 1.1 (0.7–1.6) | 0.002 | ||||
| Average cost per stay, $† | 7893.00 | 10 260.90 | 11 839.50 | 8682.30 | – | ||||
| Dichotomous | No. (%) | 95% CI | No. (%) | 95% CI | No. (%) | 95% CI | No. (%) | 95% CI | |
| Admission to ICU, yes | 3 (1.7) | 0–5 | 0 (0) | 0–1 | 0 (0) | 0–1 | 1 (3.3) | 0–17 | 0.08 |
| Inpatient palliative care referral, yes | 9 (5.1) | 2–9 | 49 (19.8) | 15–25 | 18 (90.0) | 68–99 | 0 (0) | 0–11 | < 0.001 |
| Flagged intervention, any§ | 38 (21.5) | 16–28 | 47 (19.0) | 14–24 | 7 (35.0) | 15–59 | 3 (10.0) | 2–27 | 0.2 |
| Biopsy | 13 (7.3) | 4–12 | 12 (4.8) | 3–8 | 1 (5.0) | 0–25 | 2 (6.7) | 0–22 | 0.8 |
| Endoscopy | 13 (7.3) | 4–12 | 10 (4.0) | 2–7 | 1 (5.0) | 0–25 | 0 (0) | 0–11 | 0.2 |
| Pleurocentesis¶ | 6 (3.4) | 1–7 | 12 (4.8) | 3–8 | 2 (10.0) | 1–32 | 0 (0) | 0–11 | 0.3 |
| Radiotherapy¶ | 3 (1.7) | 0–5 | 7 (2.8) | 1–6 | 2 (10.0) | 1–32 | 0 (0) | 0–11 | 0.1 |
| Dialysis | 5 (2.8) | 1–6 | 4 (1.6) | 0–4 | 0 (0) | 0–17 | 1 (3.3) | 0–17 | 0.7 |
| Paracentesis¶ | 4 (2.3) | 1–6 | 4 (1.6) | 0–4 | 2 (10.0) | 1–32 | 0 (0) | 0–11 | 0.07 |
| Vascular access device | 5 (2.8) | 1–6 | 5 (2.0) | 1–5 | 0 (0) | 0–17 | 0 (0) | 0–11 | 0.7 |
Note: CI = confidence interval, GCD = Goals of Care Designation, ICU = intensive care unit, IQR = interquartile range, LOS = length of stay.
↵* p value for LOS and Resource Intensity Weight from Krustal–Wallis test given 4 GCD categories (resuscitative, medical, comfort and no GCD); p values for all dichotomous variables from Fisher exact test given same 4 GCD categories. Tests implemented in R version 4.0.0.
↵† Calculated as: Resource Intensity Weight × Alberta’s cost of standard hospital stay for 2017–2018 ($7893).
‡ Does not include intensive palliative care unit admission. Average hours in ICU for resuscitative GCD = 1.97; no GCD = 0.53.
↵§ Flagged interventions that occurred in ≤ 1 participant not shown. Never occurred: cell saver, invasive ventilation ≥ 96 h, invasive ventilation < 96 h, parenteral nutrition, tracheostomy. Occurred once: chemotherapy (resuscitative GCD), cardioversion (resuscitative GCD), heart resuscitation (resuscitative GCD) and feeding tube (resuscitative GCD).
↵¶ These are flagged interventions that may be used to provide symptom relief or comfort care.