The following is a summary of “Determining Goal Concordant Care in the Intensive Care Unit Using Electronic Health Records,” published in the MARCH 2023 issue of Pain Management by Ahmad, et al.

The alignment of care with patient values and preferences is known as goal-concordant care (GCC). In cases of serious/critical illness, communication with patients and relatives significantly impacts GCC. Therefore, it would be practical and economical for research and quality improvement activities to study the provision of GCC using the electronic health record (EHR).

Two impartial reviewers conducted a retrospective feasibility chart review for this document. Adopting an existing framework with four questions for determining GCC. Two clinicians examined multidisciplinary notes and culled out relevant data. The main findings concerned whether the four crucial inquiries for figuring out aim concordance could be resolved utilizing data from the EHR. The goals that were determined were the secondary outcome. The level of agreement between the two reviewers was assessed using Cohen’s kappa.

A random sample of 41 patients, 35 (85%) of whom received care deemed goal-concordant (36 survivors and 5 hospital deaths), was made up. Excellent inter-rater agreement on identifying the data to determine GCC (Kappa 0.70). Patient goals were noted in about 80% of the charts we analyzed. Social work (39%), hospital progress notes (29%), palliative care (20%), and physical/occupational therapy (15%) were the note sources that provided information about patient preferences. Among the most typical patient goals recorded in the EHR were “returning home” and “becoming better/stronger.”

The patient goals can be understood via the EHR. However, the data was dispersed throughout the multidisciplinary notes. Enhancements to EHR and external validation would make it easier to determine goal concordance as a crucial outcome metric.

Reference: jpsmjournal.com/article/S0885-3924(22)00966-6/fulltext