Outcomes of a Multisite Mentored Implementation Approach to Promoting Goals of Care Conversations.
Gordon J Wood1, Rebecca K Clepp2, Jungwha Lee3
1Division of Hospital Medicine (G.J.W., A.O., J.N., E.S.), Section of Palliative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medical Education (G.J.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Journal of Pain and Symptom Management
|May 2, 2024
Summary
The Preference-Aligned Communication and Treatment (PACT) Project improved goals of care conversations for seriously ill patients. This led to care aligned with patient wishes and reduced end-of-life resource utilization.
Area of Science:
- Healthcare Quality Improvement
- Palliative Care
- Medical Ethics
Background:
- The Preference-Aligned Communication and Treatment (PACT) Project is a multisite initiative.
- PACT increases goals of care (GOC) conversations for hospitalized patients with serious illness.
Purpose of the Study:
- To assess the impact of the PACT Project on goal-discordant care.
- To evaluate the effect of PACT on end-of-life resource utilization.
Main Methods:
- Hospitals implemented a mentored quality improvement initiative for GOC conversations.
- Care discordance was assessed by comparing patient wishes to Medicare claims data.
- End-of-life resource utilization was compared between intervention and control groups using Medicare claims data.
Main Results:
- The intervention group showed low rates of care discordant with patient wishes.
- Intervention patients had lower costs, reduced ICU admissions, and fewer interventions like ventilators or CPR.
- Patients in the intervention group were more likely to enroll in hospice and had longer hospice stays.
Conclusions:
- A quality improvement intervention for seriously ill hospitalized patients aligned care with patient goals.
- The PACT Project effectively decreased end-of-life resource utilization.
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