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Infomarkers for transition to goals consistent with palliative care in dying patients

  • Yingwei Yao (a1), Janet Stifter (a2), Miriam O. Ezenwa (a1), Muhammad Lodhi (a3), Ashfaq Khokhar (a4) (a5), Rashid Ansari (a4), Gail M. Keenan (a2) (a4) (a6) and Diana J. Wilkie (a1) (a4)...

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.

Method:

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.

Significance of Results:

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.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited

Corresponding author

Address correspondence and reprint requests to: Diana J. Wilkie, Professor and Harriet H. Werley Endowed Chair for Nursing Research, and Director, Center of Excellence for End-of-Life Transition Research, Department of Biobehavioral Health Science (MC 802), College of Nursing, University of Illinois at Chicago, 845 South Damen Avenue, Room 660, Chicago, Illinois 60612-7350. E-Mail: diwilkie@uic.edu

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