title: Infomarkers for transition to goals consistent with palliative care in dying patients.
abstract: OBJECTIVE
  Electronic health records (EHRs) may contain infomarkers that identify patients near the end of life for whom it would be appropriate to shift care goals to palliative care. Discovery and use of such infomarkers could be used to conduct effectiveness research that ultimately could help to reduce the monumental cost of caring for the dying. The aim of our study was to identify changes in the plans of care that represent infomarkers, which signal a transition of care goals from nonpalliative care ones to those consistent with palliative care.
  
  
  METHODS
  Using an existing electronic health record database generated during a two-year longitudinal study of nine diverse medical-surgical units from four Midwest hospitals and a known group approach, we evaluated patient care episodes for 901 patients who died (mean age = 74.5 ± 14.6 years). We used ANOVA and Tukey's post-hoc tests to compare patient groups.
  
  
  RESULTS
  We identified 11 diagnoses, including Death Anxiety and Anticipatory Grieving, whose addition to the care plan, some of which also occurred with removal of nonpalliative care diagnoses, represent infomarkers of transition to palliative care goals. There were four categories of patients, those who had: no infomarkers on plans (n = 507), infomarkers added on the admission plan (n = 194), infomarkers added on a post-admission plan (minor transitions, n = 109), and infomarkers added and nonpalliative care diagnoses removed on a post-admission plan (major transition, n = 91). Age, length of stay, and pain outcomes differed significantly for these four categories of patients.
  
  
  CONCLUSIONS
  EHRs contain pertinent infomarkers that if confirmed in future studies could be used for timely referral to palliative care for improved focus on comfort outcomes and to identify palliative care subjects from data repositories in order to conduct big-data research, comparative effectiveness studies, and health-services research.
authors.affiliation: Department of Biobehavioral Health Science,University of Illinois at Chicago,Chicago,Illinois.
authors.forename: Yingwei
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Health System Science,College of Nursing,University of Illinois at Chicago,Chicago,Illinois.
authors.forename: Janet
authors.initials: J
authors.lastname: Stifter
authors.affiliation: Department of Biobehavioral Health Science,University of Illinois at Chicago,Chicago,Illinois.
authors.forename: Miriam O
authors.initials: MO
authors.lastname: Ezenwa
authors.affiliation: Department of Computer Science,University of Illinois at Chicago,Chicago,Illinois.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Lodhi
authors.affiliation: Department of Electrical and Computer Engineering,College of Engineering,University of Illinois at Chicago,Chicago,Illinois.
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Khokhar
authors.affiliation: Department of Electrical and Computer Engineering,College of Engineering,University of Illinois at Chicago,Chicago,Illinois.
authors.forename: Rashid
authors.initials: R
authors.lastname: Ansari
authors.affiliation: Department of Health System Science,College of Nursing,University of Illinois at Chicago,Chicago,Illinois.
authors.forename: Gail M
authors.initials: GM
authors.lastname: Keenan
authors.affiliation: Department of Biobehavioral Health Science,University of Illinois at Chicago,Chicago,Illinois.
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Wilkie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D063025:Health Information Management / Q000379:methods / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D009733:Nursing Diagnosis / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000592:standards*; D010347:Patient Care Planning / Q000592:standards*; D019452:Terminally Ill; D055815:Young Adult
keywords: Electronic health records; Infomarker; Information marker; Nursing; Palliative care