title: A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital.
abstract: OBJECTIVE
  Report the use of an objective tool, UK Gold Standards Framework (GSF) criteria, to describe the prevalence, recognition and outcomes of patients with palliative care needs in an Australian acute health setting. The rationale for this is to enable hospital doctors to identify patients who should have a patient-centred discussion about goals of care in hospital.
  
  
  METHODS
  Prospective, observational, cohort study.
  
  
  METHODS
  Adult in-patients during two separate 24 h periods.
  
  
  METHODS
  Prevalence of in-patients with GSF criteria, documentation of treatment limitations, hospital and 1 year survival, admission and discharge destination and multivariate regression analysis of factors associated with the presence of hospital treatment limitations and 1 year survival.
  
  
  RESULTS
  Of 626 in-patients reviewed, 171 (27.3%) had at least one GSF criterion, with documentation of a treatment limitation discussion in 60 (30.5%) of those patients who had GSF criteria. Hospital mortality was 9.9%, 1 year mortality 50.3% and 3-year mortality 70.2% in patients with GSF criteria. One-year mortality was highest in patients with GSF cancer (73%), renal failure (67%) and heart failure (60%) criteria. Multivariate analysis revealed age, hospital length of stay and presence of the GSF chronic obstructive pulmonary disease criteria were independently associated with the likelihood of an in-hospital treatment limitation. Non-survivors at 3 years were more likely to have a GSF cancer (25% vs 6%, p=0.004), neurological (10% vs 3%, p=0.04), or frailty (45% vs 3%, p=0.04) criteria. After multivariate logistic regression GSF cancer criteria, renal failure criteria and the presence of two or more GSF clinical criteria were independently associated with increased risk of death at 3 years. Patients returning home to live reduced from 69% (preadmission) to 27% after discharge.
  
  
  CONCLUSIONS
  The use of an objective clinical tool identifies a high prevalence of patients with palliative care needs in the acute tertiary Australian hospital setting, with a high 1 year mortality and poor return to independence in this population. The low rate of documentation of discussions about treatment limitations in this population suggests palliative care needs are not recognised and discussed in the majority of patients.
  
  
  BACKGROUND
  11/121.
authors.affiliation: Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.|Department of Medicine, Deakin University School of Medicine, Barwon Health, Geelong, Victoria, Australia.
authors.forename: Sharyn
authors.initials: S
authors.lastname: Milnes
authors.affiliation: Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.|Department of Medicine, Deakin University School of Medicine, Barwon Health, Geelong, Victoria, Australia.|Department of Epidemiology and Preventive Medicine (DEPM), Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Victoria, Australia.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Orford
authors.affiliation: Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
authors.forename: Laura
authors.initials: L
authors.lastname: Berkeley
authors.affiliation: Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.|Southern GP Training (SGPT), Drysdale Clinic, Geelong, Victoria, Australia.
authors.forename: Nigel
authors.initials: N
authors.lastname: Lambert
authors.affiliation: Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Simpson
authors.affiliation: Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
authors.forename: Tania
authors.initials: T
authors.lastname: Elderkin
authors.affiliation: Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.|Department of Medicine, Deakin University School of Medicine, Barwon Health, Geelong, Victoria, Australia.
authors.forename: Charlie
authors.initials: C
authors.lastname: Corke
authors.affiliation: Department of Epidemiology and Preventive Medicine (DEPM), Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Victoria, Australia.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-5551-1401
authors.initials: M
authors.lastname: Bailey
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D010166:Palliative Care / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D062606:Tertiary Care Centers
keywords: Chronic conditions; Clinical assessment; Hospital care; Methodological research