Implementing a Serious Illness Risk Prediction Model: Impact on Goals of Care Documentation

Area of Science:

• Quality Improvement
• Health Services Research
• Palliative Care

Background:

• Goals of care conversations are crucial for high-value care in serious illness but are infrequently documented in hospitals.
• Improving documentation of these discussions is essential for patient-centered care planning.

Purpose of the Study:

• To develop and implement a quality improvement initiative to enhance goals of care documentation for hospitalized patients.
• To assess the impact of a novel intervention on the rates and providers of goals of care documentation.

Main Methods:

• A quality improvement initiative was implemented at an academic medical center.
• The intervention integrated a 90-day mortality prediction model, a centralized documentation note, and automated notifications with targeted palliative consults.
• Documented goals of care discussions were compared before and after implementation, stratified by patient risk score.

Main Results:

• Goals of care documentation significantly increased for high-risk (17.6% to 70.8%) and intermediate-risk patients (9.6% to 28.0%) post-implementation.
• For intermediate-risk patients, palliative medicine specialists increasingly performed documentation (52.3% to 71.2%).
• For high-risk patients, primary services completed more documentation (36.8% to 47.1%), while palliative specialists' contribution slightly decreased (63.2% to 52.9%).

Conclusions:

• A goals of care initiative utilizing a mortality prediction model substantially improved documentation, particularly for high-risk patients.
• Further research is needed to optimize strategies for increasing goals of care documentation among intermediate-risk patients, especially by non-palliative care specialists.