Cost-related Outcomes Associated With Documented Goals of Care Conversations

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CONTEXT: There is limited understanding about how documented goals of care conversations (GOCC) are associated with cost-related outcomes for hospitalized patients. OBJECTIVE: To primarily assess the association of documented GOCC with specialty palliative consults (SPC) and hospital cost-related outcomes. METHODS: This multihospital, cross-sectional study, which used propensity-score matching, assessed adult patients hospitalized between 2022 and 2024 at four hospitals. We used multivariable logistic and linear regression models to identify outcomes associated with documented GOCC. RESULTS: Of 267,375 patients with median age 61 years, 19,186 had a documented GOCC and 12,300 had a SPC during hospital admission. In the propensity-score matched cohort (n = 24,600), documented GOCC with SPC were associated with decreased odds of in-hospital death (aOR 0.15, 95% CI 0.12 to 0.18), thirty-day readmission (aOR 0.68, 95% CI 0.57 to 0.82) and lower hospital length of stay (adjusted log-linear coefficient [β] -0.07, 95% CI -0.14 to -0.01). They were also associated with lower total direct hospital costs for patients surviving hospital admission (β -0.18, 95% CI -0.26 to -0.11), admitted to an ICU (β -0.13, 95% CI -0.23 to -0.03) or with GOCC documented within 48 hours of admission (β -0.28, 95% CI -0.37 to -0.19). In contrast, documented GOCC overall with or without SPC were associated with increased odds of in-hospital death (aOR 8.77, 95% CI 7.44 to 10.35, P < 0.0001) and higher hospital length of stay (β 0.25, 95% CI 0.19 to 0.31, P < 0.0001) and total direct costs (β 0.18, 95% CI 0.12 to 0.24, P < 0.0001). CONCLUSION: Early documented GOCC with SPC were associated with lower cost-related outcomes and may contribute to hospital cost-related savings.

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