Cost-related Outcomes Associated With Documented Goals of Care Conversations.

Abstract

There is limited understanding about how documented goals of care conversations (GOCC) are associated with cost-related outcomes for hospitalized patients. To primarily assess the association of documented GOCC with specialty palliative consults (SPC) and hospital cost-related outcomes. 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. 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). Early documented GOCC with SPC were associated with lower cost-related outcomes and may contribute to hospital cost-related savings.