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

• Published in: Supportive care in cancer 2024-01, Vol.32 (1), p.66-66, Article 66
• Main Authors: Leung, Cerena, Andersen, Clark R., Wilson, Kaycee, Nortje, Nico, George, Marina, Flowers, Christopher, Bruera, Eduardo, Hui, David
• Format: Article
• Language: English
• Subjects: Cancer; Cancer therapies; Comparative analysis; Critical care; Do-not-resuscitate orders; Electronic health records; Goal setting; Health care; Health services utilization; Hospitalization; Length of stay; Medical prognosis; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Mortality; Nursing; Nursing Research; Oncology; Pain Medicine; Palliative care; Palliative treatment; Patient care planning; Rehabilitation Medicine; Terminal illnesses
• ISSN: 0941-4355; 1433-7339; 1433-7339
• DOI: 10.1007/s00520-023-08265-6

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.