title: Goals of care discussions among hospitalized long-term care residents: Predictors and associated outcomes of care.
abstract: There are limited data on the occurrence, predictors, and impact of goals of care (GOC) discussions during hospitalization for seriously ill elderly patients, particularly for long-term care (LTC) residents.
  
  
  
  The study was a retrospective chart review of 200 randomly sampled LTC residents hospitalized via the emergency department and admitted to the general internal medicine service of 2 Canadian academic hospitals, from January 2012 through December 2012. We applied logistic regression models to identify factors associated with, and outcomes of, these discussions.
  
  
  
  Overall, 9.4% (665 of 7084) of hospitalizations were patients from LTC. In the sample of 200 patients, 37.5% had a documented discussion. No baseline patient characteristic was associated with GOC discussions. Low Glasgow Coma Scale, high respiratory rate, and low oxygen saturation were associated with discussions. Patients with discussions had higher rates of orders for no resuscitation (80% vs 55%) and orders for comfort measures only (7% vs 0%). In adjusted analyses, patients with discussions had higher odds of in-hospital death (52.0, 95% confidence interval [CI]: 6.2-440.4) and 1-year mortality (4.1, 95% CI: 1.7-9.6). Nearly 75% of patients with a change in their GOC did not have this documented in the discharge summary.
  
  
  
  In hospitalized LTC patients, GOC discussions occurred infrequently and appeared to be triggered by illness severity. Orders for advance directives, in-hospital death, and 1-year mortality were associated with discussions. Rates of GOC documentation in the discharge summary were poor. This study provides direction for developing education and practice standards to improve GOC discussion rates and their communication back to LTC. Journal of Hospital Medicine 2015;11:824-831. © 2015 Society of Hospital Medicine.
authors.affiliation: School of Health Policy and Management, York University, Toronto, Ontario, Canada.
authors.forename: Hannah J
authors.initials: HJ
authors.lastname: Wong
authors.affiliation: School of Health Policy and Management, York University, Toronto, Ontario, Canada.
authors.forename: Jamie
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.|Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Grinman
authors.affiliation: Division of General Internal Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Wu
mesh_terms: D016223:Advance Directives / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003142:Communication; D004282:Documentation / Q000592:standards; D005260:Female; D006760:Hospitalization; D006801:Humans; D008134:Long-Term Care; D008297:Male; D010347:Patient Care Planning; D016414:Resuscitation Orders / Q000523:psychology*; D012189:Retrospective Studies