• Sumera R Ahmad, Alex D Tarabochia, LuAnn Budahn, Allison M LeMahieu, Lioudmila V Karnatovskaia, Alison E Turnbull, and Ognjen Gajic.
• Division of Pulmonary and Critical Care Medicine (S.R.A., L.k., O.G.), Mayo Clinic, Rochester, Minnesota. Electronic address: ahmad.sumera@mayo.edu.
• J Pain Symptom Manage. 2023 Mar 1; 65 (3): e199e205e199-e205.

BackgroundGoal concordant care (GCC) is the alignment of care to patient values and preferences. GCC is a major outcome of communication with patients and families in serious/critical illness. Using the electronic health record (EHR) to study the provision of GCC would be pragmatic and cost-effective for research and quality improvement efforts.Research QuestionDo EHRs contain information to identify GCC?MethodsThis is a feasibility retrospective chart review performed by two independent reviewers. An existing framework containing four questions for identifying GCC was adopted. Two clinicians reviewed multi-disciplinary notes and extracted pertinent information. The primary outcomes were whether the four key questions for determining goal concordance could be answered using information in the EHR. The secondary outcome was the type of goals identified. Cohen's kappa was used to measure agreement between two reviewers.ResultsPatient care was considered goal concordant in 35 (85%) of 41 patients in a random sample comprising of 36 survivors and five who died in hospital. Inter-rater agreement on identifying data to determine GCC was excellent (Kappa 0.70). Patient goals were identified in 80% of charts reviewed. Note sources informative of patient preferences, included social work (39%), hospital progress notes (29%), palliative care (20%), and physical/occupational therapy (15%). "Returning home" and "getting better/ stronger" were among the most common patient goals captured in EHR.ConclusionThe EHR can be used to understand patient goals, but the information is scattered across the multi-disciplinary notes. Improving EHR and external validation will facilitate ascertainment of goal concordance as an important outcome measure.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

10 keywords...

hide…