Rural Hospital Disparities in Goals of Care Documentation

Area of Science:

• Healthcare disparities
• Patient-centered care
• Rural health outcomes

Background:

• Goals of care conversations are crucial for patient-centered care in serious illnesses.
• Understanding the prevalence of these conversations in rural settings is vital for equitable healthcare.

Purpose of the Study:

• To compare the prevalence of documented goals of care conversations between rural and nonrural hospitalized patients.
• To identify predictors of goals of care documentation in different hospital settings.

Main Methods:

• Retrospective analysis of goals of care documentation using template notes.
• Inclusion of adult patients with >30% predicted 90-day mortality from 17 community hospitals (July 2021-April 2023).
• Comparison of documentation rates and predictors between rural and nonrural hospitals.

Main Results:

• Rural patients were older, from more socioeconomically disadvantaged areas, and less likely to receive palliative care consults.
• Goals of care documentation was significantly lower in rural hospitals (2%) compared to nonrural hospitals (7%).
• After adjusting for patient characteristics and illness severity, the disparity in documentation between rural and nonrural hospitals diminished, but palliative care consults were associated with lower documentation in rural settings.

Conclusions:

• Overall prevalence of goals of care documentation is low, with rural hospitals showing particularly infrequent documentation.
• Barriers to goals of care documentation in rural hospital settings require further investigation.
• Addressing these barriers is essential to improve patient-centered care for seriously ill patients in rural communities.