Goals of Care Conversation Education Program: Impact on Resident Documentation

TL;DR

A new education program improved resident physicians' documentation of patient-centered care goals, though overall documentation rates remained low.

Contribution

The study evaluates the real-world impact of a goals of care education program on resident behavior, using a large-scale observational design.

Findings

GoCCEP-trained residents significantly increased GOC documentation compared to controls across all PGY levels.

Family medicine residents had notably higher GOC documentation rates than internal medicine residents.

Despite improvements, overall documentation rates remained low, suggesting the need for additional interventions.

Abstract

Eliciting patient-centered goals of care (GOC) leads to tailored treatment plans, better outcomes, greater patient/family/provider satisfaction. Most educational approaches elicit immediate feedback on self-perceived change in knowledge and skills (Kirkpatrick level 1 and 2). Our health system implemented Goals of Care Conversation Education Program (GoCCEP) and wished to assess if GoCCEP impacted provider behavior (Kirkpatrick level 3). GoCCEP-trained resident physicians from 7 different residency programs (2 family med {FM}, 3 internal {IM}, 1 PMR, 1 surgery) compared to matched controls from same program/year of training who didn’t take the course. Total number of unique patients seen by each resident with at least 1 GOC note identified (numerator) over total number unique patients seen by that resident (denominator) 6 months pre-GoCCEP and 6 months post-GoCCEP. Inpatients included were aged ≥65 or LACE ≥12. Z scores for differences calculated with 2 proportions test. Total of 2,067 patients with GOC notes located for 76 GoCCEP and 301 Control residents (total 312,895 unique patients). GoCCEP-trained residents increased documentation pre-post 0.6% to 1.1% (p < 0.001). GoCCEP vs. control PGY-1: 1.3% vs. 0.6% (z=-10.17, p < 0.001); PGY-2: 1.1 vs. 0.7% (z=-2.96, p < 0.004); PGY 3: 0.9% vs. 0.6% (z=-3.78, p < 0.001); PGY-3 Chief/higher: 1.1 vs.0.23% (z=-8.1, p < 0.001). Trained FM residents had significantly higher documentation than IM residents, 3.23% vs. 0.45% (z = 13.00, p < 0.001). GoCCEP associated with increased GOC documentation though overall level of documentation low regardless of year of experience. Multiple factors likely underlie these observations suggesting need for multipronged education/interventions to increase patient-centered GOCC.