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The impact of a multidisciplinary goals-of-care program on unplanned readmission rates at a comprehensive cancer center

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Abstract

Purpose

This study examined the 30-day unplanned readmission rate in the medical oncology population before and after the implementation of an institution-wide multicomponent interdisciplinary goals of care (myGOC) program.

Methods

This retrospective study compared the 30-day unplanned readmission rates in consecutive medical patients during the pre-implementation period (May 1, 2019, to December 31, 2019) and the post-implementation period (May 1, 2020, to December 31, 2020). Secondary outcomes included 7-day unplanned readmission rates, inpatient do-not-resuscitate (DNR) orders, and palliative care consults. We randomly selected a hospitalization encounter for each unique patient during each study period for statistical analysis. A multivariate analysis model was used to examine the association between 30-day unplanned readmission rates and implementation of the myGOC program.

Results

There were 7028 and 5982 unique medical patients during the pre- and post-implementation period, respectively. The overall 30-day unplanned readmission rate decreased from 24.0 to 21.3% after implementation of the myGOC program. After adjusting for covariates, the myGOC program implementation remained significantly associated with a reduction in 30-day unplanned readmission rates (OR [95% CI] 0.85 [0.77, 0.95], p = 0.003). Other factors significantly associated with a decreased likelihood of a 30-day unplanned readmission were an inpatient DNR order, advanced care planning documentation, and an emergent admission type. We also observed a significant decrease in 7-day unplanned readmission rates (OR [95% CI] 0.75 [0.64, 0.89]) after implementation of the myGOC program.

Conclusion

The 30-day and 7-day unplanned readmission rates decreased in our hospital after implementation of a system-wide multicomponent GOC intervention.

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Data Availability

Data supporting the findings of this study are available upon request from the corresponding author.

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Funding

This work was supported in part by the National Institutes of Health/NCI under award number P30CA016672 and used the Biostatistics Shared Resource.

Author information

Authors and Affiliations

  1. Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Cerena Leung & Marina George

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Clark R. Andersen

  3. Department of Inpatient Analytics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kaycee Wilson

  4. Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Nico Nortje

  5. Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Christopher Flowers

  6. Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Eduardo Bruera & David Hui

Authors
  1. Cerena Leung
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  2. Clark R. Andersen
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  8. David Hui
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Contributions

All authors contributed to the study conceptualization and design. K.W. performed data collection. C.A. performed data analysis. C.L, C.A., and D.H. wrote the original draft of the manuscript text. C.L., C.A., and D.H. prepared Tables 1, 2, 3, and 4. All authors reviewed and edited prior versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cerena Leung.

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Ethics approval

The authors certify that the study was performed in accordance with the ethical guidelines set forth by the Belmont Report. The Institutional Review Board at MDACC approved this study and provided waivers for informed consent.

Completing interests

The authors declare no competing interests.

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Leung, C., Andersen, C.R., Wilson, K. et al. The impact of a multidisciplinary goals-of-care program on unplanned readmission rates at a comprehensive cancer center. Support Care Cancer 32, 66 (2024). https://doi.org/10.1007/s00520-023-08265-6

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