Just-in-Time Decision Making: Preliminary Findings of a Goals of Care Rapid Response Team

Zhukovsky, Donna S.; Heung, Yvonne; Enriquez, Parema; Itzep, Nelda; Lu, Zhanni; Nortjé, Nico; Stanton, Penny; Wong, Angelique; Bruera, Éduardo

doi:10.1016/j.jpainsymman.2022.11.022

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…This is a pre-planned secondary analysis of a study to examine the impact of our myGOC program on hospital and patient outcomes. Details of the study design and myGOC program have been described previously [3,4,[10][11][12][13]. Because of the nature of this complex system-level intervention, randomized designs are not possible and thus we adopted a quasi-experimental design which allowed us to examine real-world data while accounting for co-variates with propensity score weighing.…”

Section: Methodsmentioning

confidence: 99%

“…A better understanding of the cost implications of GOC programs may help hospital administrators assess the value of these programs and their sustainability. In response to the COVID-19 pandemic, the University of Texas MD Anderson Cancer Center implemented a multicomponent interdisciplinary GOC (myGOC) program in March 2020 with the goal of reducing intensive care unit utilization and improving the quality of care [3,10]. We found that the implementation of the myGOC program was associated with a reduced ICU mortality rate of 6.3% and shortened average ICU length of stay by 1.4 days [3].…”

Section: Introductionmentioning

confidence: 93%

“…Details the of myGOC program have been published elsewhere [3,10,11,13]. Briefly, the myGOC program is an institute-wide initiative involving hospitalist service, palliative care, medical oncology, hematology, surgical oncology, emergency medicine, intensive care, nursing, case management, social work, chaplaincy, clinical ethics and senior leadership.…”

Section: Mygoc Programmentioning

confidence: 99%

See 2 more Smart Citations

Cost of Hospitalization Associated with Inpatient Goals-of-Care Program Implementation at a Comprehensive Cancer Center: A Propensity Score Analysis

Hui,

Huang,

Andersen

et al. 2024

Cancers

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The impact of goals-of-care programs on acute hospitalization costs is unclear. We compared the hospitalization cost in an 8-month period before implementation of a multimodal interdisciplinary goals-of-care program (1 May 2019 to 31 December 2019) to an 8-month period after program implementation (1 May 2020 to 31 December 2020). Propensity score weighting was used to adjust for differences in potential covariates. The primary outcome was total direct cost during the hospital stay for each index hospitalization. This analysis included 6977 patients in 2019 and 5964 patients in 2020. The total direct cost decreased by 3% in 2020 but was not statistically significant (ratio 0.97, 95% CI 0.92, 1.03). Under individual categories, there was a significant decrease in medical oncology (ratio 0.58, 95% CI 0.50, 0.68) and pharmacy costs (ratio 0.86, 95% CI 0.79, 0.96), and an increase in room and board (ratio 1.06, 95% CI 1.01, 1.10). In subgroup analysis, ICU patients had a significant reduction in total direct cost after program implementation (ratio 0.83, 95% CI 0.72, 0.94). After accounting for the length of ICU admission, we found that the total direct cost per hospital day was no longer different between 2019 and 2020 (ratio 0.986, 95% CI 0.92, 1.05), suggesting that shorter ICU admissions likely explained much of the observed cost savings. This study provides real-world data on how “in-the-moment” GOC conversations may contribute to reduced hospitalization costs among ICU patients.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Mygoc Programmentioning

confidence: 99%

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Cost of Hospitalization Associated with Inpatient Goals-of-Care Program Implementation at a Comprehensive Cancer Center: A Propensity Score Analysis

Hui,

Huang,

Andersen

et al. 2024

Cancers

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“…These coordinated visits can be advantageous for cancer patients, especially during the transition of care or goals of care discussion. Telemedicine can help provide a “just-in-time” model of advance care planning and goals of care discussion in the inpatient setting by including multiple specialties and disciplines in family meetings on short notice [ 17 ]. This model enables clinicians to deliver a cohesive message while bringing their unique expertise and collaboration to develop a goal-concordant plan for patients and families.…”

Section: Introductionmentioning

confidence: 99%

Best Practices for Providing Patient-Centered Tele-Palliative Care to Cancer Patients

Aldana

Evoh

Reddy

2023

Cancers

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Cancer patients receiving palliative care may face significant challenges in attending outpatient appointments. Patients on controlled substances such as opioids require frequent visits and often rely on assistive devices and/or a caregiver to accompany them to these visits. In addition, pain, fatigue, and shortness of breath may magnify the challenges associated with in-person visits. The rapid adoption of telemedicine in response to the COVID-19 pandemic has proven to be highly beneficial for advanced cancer patients and caregivers. The hurried COVID-19-related implementation of telemedicine is now evolving into a permanent platform for providing palliative care. This review will focus on the best practices and recommendations to deliver high-quality, interdisciplinary tele-palliative care.

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The impact of a multidisciplinary goals-of-care program on unplanned readmission rates at a comprehensive cancer center

Leung,

Andersen,

Wilson

et al. 2023

Support Care Cancer

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Just-in-Time Decision Making: Preliminary Findings of a Goals of Care Rapid Response Team

Cited by 7 publications

References 22 publications

Cost of Hospitalization Associated with Inpatient Goals-of-Care Program Implementation at a Comprehensive Cancer Center: A Propensity Score Analysis

Cost of Hospitalization Associated with Inpatient Goals-of-Care Program Implementation at a Comprehensive Cancer Center: A Propensity Score Analysis

Best Practices for Providing Patient-Centered Tele-Palliative Care to Cancer Patients

The impact of a multidisciplinary goals-of-care program on unplanned readmission rates at a comprehensive cancer center

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