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

Cerena Leung; Clark R Andersen; Kaycee Wilson; Nico Nortje; Marina George; Christopher Flowers; Eduardo Bruera; David Hui

doi:10.1007/s00520-023-08265-6

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

Support Care Cancer. 2023 Dec 27;32(1):66. doi: 10.1007/s00520-023-08265-6.

Authors

Cerena Leung¹, Clark R Andersen², Kaycee Wilson³, Nico Nortje⁴, Marina George⁵, Christopher Flowers⁶, Eduardo Bruera⁷, David Hui⁷

Affiliations

¹ Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. CKLeung2@mdanderson.org.
² Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
³ Department of Inpatient Analytics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁵ Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁶ Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁷ Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

PMID: 38150077
DOI: 10.1007/s00520-023-08265-6

Abstract

Purpose: This study examined the 30-day unplanned readmission rate in the medical oncology population before and after the implementation of an institution-wide multicomponent interdisciplinary goals of care (myGOC) program.

Methods: This retrospective study compared the 30-day unplanned readmission rates in consecutive medical patients during the pre-implementation period (May 1, 2019, to December 31, 2019) and the post-implementation period (May 1, 2020, to December 31, 2020). Secondary outcomes included 7-day unplanned readmission rates, inpatient do-not-resuscitate (DNR) orders, and palliative care consults. We randomly selected a hospitalization encounter for each unique patient during each study period for statistical analysis. A multivariate analysis model was used to examine the association between 30-day unplanned readmission rates and implementation of the myGOC program.

Results: There were 7028 and 5982 unique medical patients during the pre- and post-implementation period, respectively. The overall 30-day unplanned readmission rate decreased from 24.0 to 21.3% after implementation of the myGOC program. After adjusting for covariates, the myGOC program implementation remained significantly associated with a reduction in 30-day unplanned readmission rates (OR [95% CI] 0.85 [0.77, 0.95], p = 0.003). Other factors significantly associated with a decreased likelihood of a 30-day unplanned readmission were an inpatient DNR order, advanced care planning documentation, and an emergent admission type. We also observed a significant decrease in 7-day unplanned readmission rates (OR [95% CI] 0.75 [0.64, 0.89]) after implementation of the myGOC program.

Conclusion: The 30-day and 7-day unplanned readmission rates decreased in our hospital after implementation of a system-wide multicomponent GOC intervention.

Keywords: Advanced care planning; Goals of care; Palliative care; Quality of health care; Readmission rates.

MeSH terms

Goals
Hospitalization
Humans
Inpatients
Neoplasms* / therapy
Patient Readmission*
Retrospective Studies