Table. Adjusted Changes in Serious Illness Conversations and End-of-Life Outcomes.
| No./total No. (%) of encounters | Odds of an SIC, aOR (95% CI)a | P value | ||
|---|---|---|---|---|
| Control period | Intervention period | |||
| SICs | ||||
| All patient encounters | 158/12 356 (1.3) | 1262/28 665 (4.4) | 2.09 (1.53-2.87) | <.001 |
| Encounters with high-risk patientsb | 59/1754 (3.4) | 510/3765 (13.5) | 2.62 (1.84-3.72) | <.001 |
| Encounters with non–high-risk patients | 99/10 602 (0.9) | 752/24 899 (3.0) | 2.07 (1.52-2.82) | <.001 |
| Deceased patients | 42/215 (19.5) | 377/1202 (31.4) | 2.44 (1.35-4.42) | <.001 |
| End-of-life outcomes | ||||
| All patients | ||||
| Inpatient deathc | 27/231 (11.7) | 114/957 (11.9) | 1.72 (0.7-4.24) | .24 |
| ICU admission within 30 d of deathc | 39/231 (16.9) | 150/957 (15.7) | 1.04 (0.54-1.98) | .92 |
| Enrolled in hospicec | 93/156 (59.6) | 424/700 (60.6) | 1.42 (0.78-2.59) | .25 |
| Hospice length of stay, mean (SD), dd | 23.90 (40.77) | 25.53 (37.01) | 1.26 (0.67-2.37) | .47 |
| Systemic therapy within 14 d of deathc | 24/231 (10.4) | 72/957 (7.5) | 0.25 (0.11-0.57) | .001 |
| High-risk patients | ||||
| Inpatient death | 22/181 (12.2) | 83/696 (11.9) | 1.8 (0.63-5.13) | .27 |
| ICU admission within 30 d of death | 28/181 (15.5) | 120/696 (17.2) | 1.12 (0.51-2.45) | .77 |
| Enrolled in hospicec | 79/124 (63.7) | 340/525 (64.8) | 1.53 (0.72-3.25) | .27 |
| Hospice length of stay, mean (SD), dd | 26.33 (43.53) | 25.03 (36.65) | 1.24 (0.64-2.41) | .53 |
| Systemic therapy within 14 d of deathc | 15/181 (8.3) | 50/696 (7.2) | 0.37 (0.13-1.04) | .06 |
| Non–high-risk patients | ||||
| Inpatient death | 5/50 (10) | 31/261 (11.9) | 1.03 (0.62-1.69) | .92 |
| ICU admission within 30 d of death | 11/50 (22) | 30/261 (11.5) | 0.96 (0.63-1.47) | .87 |
| Enrolled in hospicec | 14/32 (43.8) | 84/175 (48) | 1.31 (0.96-1.79) | .08 |
| Hospice length of stay, mean (SD), dd | 25.03 (33.46) | 26.39 (35.46) | 0.68 (0.18-2.56) | .57 |
| Systemic therapy within 14 d of death | 9/70 (12.90) | 22/347 (6.30) | 0.84 (0.44-1.61) | .61 |
Abbreviations: aOR, adjusted odds ratio; ICU, intensive care unit; SIC, serious illness conversation.
a
Adjusted for intervention, clinic group, and wedge, and clustered at the oncologist level.
b
High-risk patients were defined as having a 10% or greater risk of death within 180 days, as identified by a prospectively validated machine learning algorithm.
c
End-of-life inpatient and systemic therapy data available for 1188 patients.
d
Hospice outcomes available for 856 patients who were eligible for health system–affiliated hospice.