Integrating Goals-of-Care Documentation Into the Electronic Health Record: Three-Year Results and Insights of the Improving Goal Concordant Care (IGCC) Initiative Across 10 Cancer Centers.

内容摘要

Earlier and more frequent goals-of-care conversations (GOCCs) for patients with cancer have the potential to enhance person-centered care delivery. Structured electronic health record (EHR) functionality may support more consistent GOCCs and documentation; however, large-scale, multisite implementations remain limited. This study describes the implementation and evaluation of EHR-based goals-of-care documentation (GOCD) across 10 dedicated cancer centers participating in the Improving Goal Concordant Care (IGCC) initiative. The IGCC initiative was a multicomponent collaborative quality improvement project led by the Alliance of Dedicated Cancer Centers (ADCC) between 2020 and 2023. Participants developed a consensus definition of structured EHR GOCD to guide implementation at participating sites. Centers also used a range of enabling strategies to promote GOCD. Evaluation included process assessments and quarterly reporting on the percentage of deceased patients with at least one documented GOCC. All 10 sites implemented structured GOCD templates. Across the study period, aggregate GOCD rates improved significantly, increasing from 18% to 37% among all decedents and from 25% to 52% among inpatient decedents. However, the collaborative consensus goal of 70% was not achieved. Significant improvements in GOCD rates were observed among all decedents in 5 of 8 centers and among inpatient decedents in 6 of 9 centers. Sites that implemented clinician nudges or financial incentives achieved significantly higher final GOCD rates. This multicenter initiative demonstrated that structured EHR tools, paired with institutional engagement and behavioral strategies, can improve documentation of GOCCs in oncology. Variation in implementation across sites highlights the importance of local adaptation and sustained programmatic support in driving meaningful practice change.