Table 2.
Secondary process and outcome measures
| Outcome Measure | Variable Definition and Coding |
|---|---|
| Change in code status | Categorical: no change, new limitations on life support (e.g., DNAR, DNI), or discontinued limitations on life support |
| Initiation of additional forms of life support (e.g., acute dialysis, gastrostomy tube) | Binary; yes if CPT code 90935, 90937, 49440, 49441, or 43830 |
| Palliative care consult | Binary; yes if palliative care consult order |
| Time to palliative care consult | Continuous (h); time starts at enrollment |
| Palliative withdrawal of mechanical ventilation | Binary; yes if time of comfort-care order* precedes time of hospital death |
| Receipt of CPR | Binary; yes if CPT code 92950 |
| ICU mortality | Binary; yes if death occurred in the ICU or within 1 d of transfer out of ICU |
| ICU length of stay | Continuous (h); time starts at enrollment |
| ICU readmission | Binary; yes if readmitted to any ICU during same hospital encounter |
| Duration mechanical ventilation | Continuous (h); time starts at enrollment |
| Time to withdrawal of life support | Continuous (h); time starts at enrollment and ends at time of comfort-care order |
| Hospital discharge disposition | Categorical |
| Quality of Dying and Death questionnaire (1 item)† | Continuous; nurse-reported postmortem |
| 30-d hospital readmission‡ | Count |
| 30-d all-cause mortality§ | Binary; time starts at enrollment |
| 90-d all-cause mortality§ | Binary; time starts at enrollment |
| 180-d all-cause mortality§ | Binary; time starts at enrollment |
Definition of abbreviations: CPR = cardiopulmonary resuscitation; CPT = Current Procedural Terminology; DNAR = do not attempt resuscitation; DNI = do not intubate; ICU = intensive care unit.
*
Sensitivity 85.7% among 112 cases with palliative withdrawal of mechanical ventilation across participating ICUs.
†
“Overall, how would you rate the quality of the patient’s dying?” (score ranges from 0 = terrible experience to 10 = almost perfect experience) (102).
‡
Includes admission to any Atrium Health acute care hospital.
§
Date of death determined from the electronic health record primarily and Social Security Death Index database secondarily (119).