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

Care that is congruent with patients’ beliefs and desires is called goal-concordant care (GCC). GCC is crucial to communication for patients and families dealing with an acute or life-threatening disease. It would be practical and economical for research and quality improvement activities to use the electronic health record (EHR) to study the provision of GCC. Is there data for GCC detection in EHRs? There were 2 separate reviewers for this retrospective chart evaluation of feasibility. To spot GCC, a preexisting framework consisting of four questions was utilized. The 2 doctors went over the interdisciplinary notes and culled the important details. 

The primary results were based on whether or not the 4 primary questions for assessing goal concordance could be addressed using data from the EHR. Types of objectives were a secondary result. The 2 reviewers’ agreement was calculated using Cohen’s kappa. Mainly 35 (85%) of the 41 patients in a random sample of 36 survivors and 5 in-hospital deaths were deemed to have received care congruent with their stated goals. 

Excellent concordance was found between raters when using identifying data to diagnose GCC (Kappa 0.70). 

At least 1 patient goal was noted in 80% of the charts. Social work notes (39%), hospital progress notes (29%), palliative care notes (20%), and physical/occupational therapy notes (15%) were found to be informative of patient preferences. Patient goals of “returning home” and “growing better/stronger” were among the most frequently recorded in electronic health records. Although the EHR can help with patient objectives analysis, the data is dispersed between the various practitioners’ notes. The determination of goal concordance as a crucial outcome measure will be facilitated by enhanced EHR and external validation.

Source: sciencedirect.com/science/article/pii/S0885392422009666