PP10.007 Associations between goals of care designation orders and health resource utilization: prospective cohort study of older, seriously Ill hospitalized adults
Bibliographic record
Abstract
Background One ACP aim is achieving goal concordant care. The Goals of Care Designation (GCD) is a medical order communicating the focus of a patient’s care in Alberta, Canada. GCDs are created to align patient values and beliefs with clinicians’ medical expertise in determining care goals. We sought the association between GCD type (resuscitative, medical or comfort) and in-hospital resource use. Methods Prospective cohort study of newly hospitalized in-patients, ≥55 years with chronic obstructive pulmonary disease, heart failure, cirrhosis, cancer or kidney failure; prospected <6 month survival by a healthcare provider; or ≥80 years with any acute condition. The exposure of interest was GCD. The primary outcome was health resource use during admission, measured by length of stay (LOS), intensive care unit hours, Resource Intensity Weights (RIWs), flagged interventions, and palliative care referral. The secondary outcome was 30-day readmission. Regression analyses were adjusted for age, sex, race, frailty, and comorbidities. Results Of 475 participants, median age 83 years (interquartile range 77–87), 93.7% had a GCD at enrolment. Relative to patients with resuscitative GCD, patients with medical GCD had a longer LOS (1.42 times, 95% confidence interval [CI] 1.10–1.83) and a higher RIW (adjusted ratio 1.14, 95% CI 1.02–1.28). Patients with comfort or medical GCD had a higher likelihood of palliative care referral (comfort GCD adjusted relative risk (RR) 9.32, 95% CI 4.32–20.08; medical GCD adjusted RR 3.58, 95% CI 1.75–7.33) but not flagged intervention use (comfort GCD adjusted RR 1.06, 95% CI 0.49–2.28; medical GCD adjusted RR 0.98, 95% CI 0.48–2.02). Last recorded GCD was highly associated with death and discharge location (p<0.001) but not 30-day readmission. Conclusion GCD early during admission was associated with LOS, RIW and palliative care referral. This suggests an alignment between health resource use and the focus of care communicated by each GCD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".