The impact of a multidisciplinary goals-of-care program on unplanned readmission rates at a comprehensive cancer center

Leung, Cerena; Andersen, Clark R.; Wilson, Kaycee; Nortje, Nico; George, Marina; Flowers, Christopher; Bruera, Eduardo; Hui, David

doi:10.1007/s00520-023-08265-6

Cited by 1 publication

(2 citation statements)

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“…This is a pre-planned secondary analysis of a study to examine the impact of our myGOC program on hospital and patient outcomes. Details of the study design and myGOC program have been described previously [3,4,[10][11][12][13]. Because of the nature of this complex system-level intervention, randomized designs are not possible and thus we adopted a quasi-experimental design which allowed us to examine real-world data while accounting for co-variates with propensity score weighing.…”

Section: Methodsmentioning

confidence: 99%

“…Goals-of-care (GOC) discussions aim to improve illness understanding and facilitate decision making while respecting patients' expressed values and goals. GOC interventions have been found to be associated with improved outcomes, such as decreased intensive care unit utilization, 30-day unplanned readmission, and chemotherapy use at the end of life, and increased advance care plan documentation and hospice use [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Cost of Hospitalization Associated with Inpatient Goals-of-Care Program Implementation at a Comprehensive Cancer Center: A Propensity Score Analysis

Hui,

Huang,

Andersen

et al. 2024

Cancers

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The impact of goals-of-care programs on acute hospitalization costs is unclear. We compared the hospitalization cost in an 8-month period before implementation of a multimodal interdisciplinary goals-of-care program (1 May 2019 to 31 December 2019) to an 8-month period after program implementation (1 May 2020 to 31 December 2020). Propensity score weighting was used to adjust for differences in potential covariates. The primary outcome was total direct cost during the hospital stay for each index hospitalization. This analysis included 6977 patients in 2019 and 5964 patients in 2020. The total direct cost decreased by 3% in 2020 but was not statistically significant (ratio 0.97, 95% CI 0.92, 1.03). Under individual categories, there was a significant decrease in medical oncology (ratio 0.58, 95% CI 0.50, 0.68) and pharmacy costs (ratio 0.86, 95% CI 0.79, 0.96), and an increase in room and board (ratio 1.06, 95% CI 1.01, 1.10). In subgroup analysis, ICU patients had a significant reduction in total direct cost after program implementation (ratio 0.83, 95% CI 0.72, 0.94). After accounting for the length of ICU admission, we found that the total direct cost per hospital day was no longer different between 2019 and 2020 (ratio 0.986, 95% CI 0.92, 1.05), suggesting that shorter ICU admissions likely explained much of the observed cost savings. This study provides real-world data on how “in-the-moment” GOC conversations may contribute to reduced hospitalization costs among ICU patients.

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