The lack of documentation of preferences in a cohort of adults who died after ischemic stroke

Maisha T. Robinson, Barbara G. Vickrey, Robert G. Holloway, Kelly Chong, Linda Williams, Robert H. Brook, Mei Leng, Punam Parikh, David S. Zingmond

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: To measure the extent and timing of physicians' documentation of communication with patients and families regarding limitations on life-sustaining interventions, in a population cohort of adults who died within 30 days after hospitalization for ischemic stroke. Methods: We used the California Office of Statewide Health Planning and Development Patient Discharge Database to identify a retrospective cohort of adults with ischemic strokes at all California acute care hospitals from December 2006 to November 2007. Of 326 eligible hospitals, a representative sample of 39 was selected, stratified by stroke volume and mortality. Medical records of 981 admissions were abstracted, oversampled on mortality and tissue plasminogen activator receipt. Among 198 patients who died by 30 days postadmission, overall proportions and timing of documented preferences were calculated; factors associated with documentation were explored. Results: Of the 198 decedents, mean age was 80 years, 78% were admitted from home, 19% had mild strokes, 11% received tissue plasminogen activator, and 42% died during the index hospitalization. Preferences about at least one life-sustaining intervention were recorded on 39% of patients: cardiopulmonary resuscitation 34%, mechanical ventilation 23%, nasogastric tube feeding 10%, and percutaneous enteral feeding 6%. Most discussions occurred within 5 days of death. Greater stroke severity was associated with increased in-hospital documentationof preferences (p , 0.05). Conclusions: Documented discussions about limitations on life-sustaining interventions during hospitalization were low, even though this cohort died within 30 days poststroke. Improving the documentation of preferences may be difficult given the 2015 Centers for Medicare and Medicaid 30-day stroke mortality hospital performance measure that is unadjusted for patient preferences regarding life-sustaining interventions.

Original languageEnglish (US)
Pages (from-to)2056-2062
Number of pages7
JournalNeurology
Volume86
Issue number22
DOIs
StatePublished - May 31 2016

Fingerprint

Documentation
Stroke
Hospitalization
Enteral Nutrition
Tissue Plasminogen Activator
Health Planning
Mortality
Patient Preference
Patient Discharge
Cardiopulmonary Resuscitation
Medicaid
Medicare
Hospital Mortality
Artificial Respiration
Stroke Volume
Medical Records
Communication
Databases
Physicians
Population

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Robinson, M. T., Vickrey, B. G., Holloway, R. G., Chong, K., Williams, L., Brook, R. H., ... Zingmond, D. S. (2016). The lack of documentation of preferences in a cohort of adults who died after ischemic stroke. Neurology, 86(22), 2056-2062. https://doi.org/10.1212/WNL.0000000000002625

The lack of documentation of preferences in a cohort of adults who died after ischemic stroke. / Robinson, Maisha T.; Vickrey, Barbara G.; Holloway, Robert G.; Chong, Kelly; Williams, Linda; Brook, Robert H.; Leng, Mei; Parikh, Punam; Zingmond, David S.

In: Neurology, Vol. 86, No. 22, 31.05.2016, p. 2056-2062.

Research output: Contribution to journalArticle

Robinson, MT, Vickrey, BG, Holloway, RG, Chong, K, Williams, L, Brook, RH, Leng, M, Parikh, P & Zingmond, DS 2016, 'The lack of documentation of preferences in a cohort of adults who died after ischemic stroke', Neurology, vol. 86, no. 22, pp. 2056-2062. https://doi.org/10.1212/WNL.0000000000002625
Robinson, Maisha T. ; Vickrey, Barbara G. ; Holloway, Robert G. ; Chong, Kelly ; Williams, Linda ; Brook, Robert H. ; Leng, Mei ; Parikh, Punam ; Zingmond, David S. / The lack of documentation of preferences in a cohort of adults who died after ischemic stroke. In: Neurology. 2016 ; Vol. 86, No. 22. pp. 2056-2062.
@article{1236a3d4ac06454f9f5f989358f5b97b,
title = "The lack of documentation of preferences in a cohort of adults who died after ischemic stroke",
abstract = "Objective: To measure the extent and timing of physicians' documentation of communication with patients and families regarding limitations on life-sustaining interventions, in a population cohort of adults who died within 30 days after hospitalization for ischemic stroke. Methods: We used the California Office of Statewide Health Planning and Development Patient Discharge Database to identify a retrospective cohort of adults with ischemic strokes at all California acute care hospitals from December 2006 to November 2007. Of 326 eligible hospitals, a representative sample of 39 was selected, stratified by stroke volume and mortality. Medical records of 981 admissions were abstracted, oversampled on mortality and tissue plasminogen activator receipt. Among 198 patients who died by 30 days postadmission, overall proportions and timing of documented preferences were calculated; factors associated with documentation were explored. Results: Of the 198 decedents, mean age was 80 years, 78{\%} were admitted from home, 19{\%} had mild strokes, 11{\%} received tissue plasminogen activator, and 42{\%} died during the index hospitalization. Preferences about at least one life-sustaining intervention were recorded on 39{\%} of patients: cardiopulmonary resuscitation 34{\%}, mechanical ventilation 23{\%}, nasogastric tube feeding 10{\%}, and percutaneous enteral feeding 6{\%}. Most discussions occurred within 5 days of death. Greater stroke severity was associated with increased in-hospital documentationof preferences (p , 0.05). Conclusions: Documented discussions about limitations on life-sustaining interventions during hospitalization were low, even though this cohort died within 30 days poststroke. Improving the documentation of preferences may be difficult given the 2015 Centers for Medicare and Medicaid 30-day stroke mortality hospital performance measure that is unadjusted for patient preferences regarding life-sustaining interventions.",
author = "Robinson, {Maisha T.} and Vickrey, {Barbara G.} and Holloway, {Robert G.} and Kelly Chong and Linda Williams and Brook, {Robert H.} and Mei Leng and Punam Parikh and Zingmond, {David S.}",
year = "2016",
month = "5",
day = "31",
doi = "10.1212/WNL.0000000000002625",
language = "English (US)",
volume = "86",
pages = "2056--2062",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "22",

}

TY - JOUR

T1 - The lack of documentation of preferences in a cohort of adults who died after ischemic stroke

AU - Robinson, Maisha T.

AU - Vickrey, Barbara G.

AU - Holloway, Robert G.

AU - Chong, Kelly

AU - Williams, Linda

AU - Brook, Robert H.

AU - Leng, Mei

AU - Parikh, Punam

AU - Zingmond, David S.

PY - 2016/5/31

Y1 - 2016/5/31

N2 - Objective: To measure the extent and timing of physicians' documentation of communication with patients and families regarding limitations on life-sustaining interventions, in a population cohort of adults who died within 30 days after hospitalization for ischemic stroke. Methods: We used the California Office of Statewide Health Planning and Development Patient Discharge Database to identify a retrospective cohort of adults with ischemic strokes at all California acute care hospitals from December 2006 to November 2007. Of 326 eligible hospitals, a representative sample of 39 was selected, stratified by stroke volume and mortality. Medical records of 981 admissions were abstracted, oversampled on mortality and tissue plasminogen activator receipt. Among 198 patients who died by 30 days postadmission, overall proportions and timing of documented preferences were calculated; factors associated with documentation were explored. Results: Of the 198 decedents, mean age was 80 years, 78% were admitted from home, 19% had mild strokes, 11% received tissue plasminogen activator, and 42% died during the index hospitalization. Preferences about at least one life-sustaining intervention were recorded on 39% of patients: cardiopulmonary resuscitation 34%, mechanical ventilation 23%, nasogastric tube feeding 10%, and percutaneous enteral feeding 6%. Most discussions occurred within 5 days of death. Greater stroke severity was associated with increased in-hospital documentationof preferences (p , 0.05). Conclusions: Documented discussions about limitations on life-sustaining interventions during hospitalization were low, even though this cohort died within 30 days poststroke. Improving the documentation of preferences may be difficult given the 2015 Centers for Medicare and Medicaid 30-day stroke mortality hospital performance measure that is unadjusted for patient preferences regarding life-sustaining interventions.

AB - Objective: To measure the extent and timing of physicians' documentation of communication with patients and families regarding limitations on life-sustaining interventions, in a population cohort of adults who died within 30 days after hospitalization for ischemic stroke. Methods: We used the California Office of Statewide Health Planning and Development Patient Discharge Database to identify a retrospective cohort of adults with ischemic strokes at all California acute care hospitals from December 2006 to November 2007. Of 326 eligible hospitals, a representative sample of 39 was selected, stratified by stroke volume and mortality. Medical records of 981 admissions were abstracted, oversampled on mortality and tissue plasminogen activator receipt. Among 198 patients who died by 30 days postadmission, overall proportions and timing of documented preferences were calculated; factors associated with documentation were explored. Results: Of the 198 decedents, mean age was 80 years, 78% were admitted from home, 19% had mild strokes, 11% received tissue plasminogen activator, and 42% died during the index hospitalization. Preferences about at least one life-sustaining intervention were recorded on 39% of patients: cardiopulmonary resuscitation 34%, mechanical ventilation 23%, nasogastric tube feeding 10%, and percutaneous enteral feeding 6%. Most discussions occurred within 5 days of death. Greater stroke severity was associated with increased in-hospital documentationof preferences (p , 0.05). Conclusions: Documented discussions about limitations on life-sustaining interventions during hospitalization were low, even though this cohort died within 30 days poststroke. Improving the documentation of preferences may be difficult given the 2015 Centers for Medicare and Medicaid 30-day stroke mortality hospital performance measure that is unadjusted for patient preferences regarding life-sustaining interventions.

UR - http://www.scopus.com/inward/record.url?scp=84973570966&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84973570966&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000002625

DO - 10.1212/WNL.0000000000002625

M3 - Article

C2 - 27060165

AN - SCOPUS:84973570966

VL - 86

SP - 2056

EP - 2062

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 22

ER -