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Soliciting Patients Goals for Care on Hospital Discharge the Gateway to Shared Decision-making

Background: To determine the frequency and type of adult patients goals for care during and after hospitalization.

Methods: As part of a larger readmission reduction study, between 10/1/10 and 11/30/13, goals for care were solicited and recorded by nurses and social workers after Coleman model readmission reduction training which included soliciting patient’s goals for care in hospital, and then again at a home visit. Patients consisted of a consenting convenience sample of Medicare, Medicare Advantage, commercial, Medicaid HMO and uninsured patients discharged from three Monroe County, NY hospitals with an NYU Preventable Admission Algorithm diagnosis. Patient age, gender,ethnicity, and elicited goals were recorded. Qualitative analysis was applied to determine the frequency and percent of medical versus non-medical goals. Further analysis determined if goals were specific or general.

Results: 1411 patients participated in the study: 39.3% were ages 46-65, 34.2% ages 66-80; 67.4% were Caucasian, 23.3% African-American, and 3.9% Hispanic. No goal was recorded for 41% of inpatients 19% of home visits. Overall, 2127 goals were elicited, 469 in hospital, and 1658 at home. 54.95% of home elicited goals were medical and 45.05% non-medical. The most common in-hospital goal was “get out of the hospital”.

Conclusion: Patient’s goals for care are often non-medical, The goal solicitation process is most appropriately conducted after discharge. Identifying non-medical goals may be important in beginning the shared decision-making process. By using patient identified goals as a starting point of medical decision making, patients may more clearly identify with the medical objectives presented to them. Research is needed to determine optimal solicitation approaches to most effectively identify patients’ and families’ goals for care and then prospectively asses the effect of goal solicitation on health outcomes.

Author(s): Alice M Beckman, Melissa Wendland, Eva Cohen, Brenda Bartock, Jeanne Chirico & Howard Beckman

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