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Impact of Pediatric Palliative Care on Goal Concordant Care in the Neonatal Intensive Care Unit
Matthew Lin1, Sadaf Kazmi2, Olivia Bosworth2
1New York University Grossman School of Medicine (M.L., S.K., O.B., T.K., J.N.), Department of Pediatrics, Division of Neonatology, New York, New York, USA; New York University School Grossman of Medicine (M.L., D.D., D.E., C.Z.), Department of Pediatrics, Pediatric Advanced Care Team, New York, New York, USA.
Insights
Most infants in the NICU received goal-concordant care (GCC), which could be identified from chart data. Pediatric palliative care (PPC) consultation was associated with GCC but not a significant predictor after adjustments.
Area of Science:
- Neonatal Medicine
- Palliative Care
- Health Services Research
Background:
- The prevalence of goal-concordant care (GCC) in Neonatal Intensive Care Units (NICUs) is largely unknown.
- The feasibility of measuring GCC using electronic health record data requires investigation.
Purpose of the Study:
- To assess if GCC can be reliably evaluated from NICU chart data.
- To identify demographic and clinical factors associated with GCC.
- To determine the impact of pediatric palliative care (PPC) consultation on GCC.
Main Methods:
- Retrospective chart review of infants who died in a level IV NICU (2014-2024).
- Independent chart abstraction by two reviewers using a structured questionnaire for GCC outcomes.
- Statistical analyses including Cohen's kappa, Mann-Whitney U, Chi-square/Fisher's exact tests, and logistic regression.
Main Results:
- Approximately 78% of infants received GCC, identifiable from chart data.
- GCC was associated with religious tradition, insurance, resuscitation limitations, mode of death, PPC consult, family meetings, and social work visits.
- PPC consultation was not a significant predictor of GCC after adjusting for confounding factors.
Conclusions:
- Goal-concordant care is achievable and measurable in the NICU setting using chart data.
- Demographic and psychosocial factors, including PPC consultation, are associated with GCC.
- While associated, PPC consultation's independent impact on achieving GCC requires further study.
Context:
Little is known about the prevalence of goal-concordant care (GCC) in the NICU and whether it can be measured from chart data.
Objectives:
To determine if GCC can be evaluated using chart data, to identify factors associated with GCC, and to evaluate the impact of pediatric palliative care (PPC) consultation on GCC.
Methods:
Retrospective review of infants who died in a level IV NICU over a 10-year period (2014-2024). A structured questionnaire was used to guide independent chart abstraction for GCC outcomes between two reviewers. Cohen's kappa was used to measure reviewer agreement. Mann-Whitney U and Chi-square or Fisher's exact tests were used to evaluate differences between infants with GCC vs. no GCC. Logistic regression was used to evaluate the impact of PPC on aspects of GCC.
Results:
About 78% (99/127) of patients received GCC. Reviewer agreement for determining aspects of GCC was low, however, consensus was reached for all GCC outcomes. GCC was significantly associated with religious tradition, insurance status, limitations of resuscitation, mode of death, PPC consult, any family meeting or advance care planning discussion, and more social work visits. In logistic regression, PPC consultation was not a significant predictor of GCC after adjusting for religion, insurance, time since death, length of stay, and family meetings.
Conclusion:
Most infants received GCC, which was able to be determined from chart data. GCC was associated with several demographic and hospitalization factors such as PPC consultation and psychosocial supports. After adjusting for confounding, PPC was not a significant predictor of GCC.
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