May 2022

GERIATRICS

DETERMINING WHAT MATTERS MOST TO HOSPITALIZED PATIENTS: A QUALITATIVE ANALYSIS

 Featuring: ​Alexandra Petrakos, MD
​
Background: What Matters Most (WMM) to patients is a foundation of the 4Ms of age-friendly care. WMM to hospitalized older adults has not been well described. We aimed to identify themes of WMM documented in the electronic medical record (EMR) of hospitalized older adults.

Methods: We assembled a prospective cohort between Apr-Oct 2021 on an academic hospital’s Acute Care for Elders (ACE) unit that was implementing the 4Ms and staffed by geriatricians, house staff and nurse practitioners. Patients >65 years with WMM documented in the EMR during hospitalization were included. We excluded those who
were discharged in <24 hours, transferred to another unit, discharged against medical advice or on hospice, or died during hospitalization. 

Demographics, cognitive impairment (dementia, mild cognitive impairment, delirium), primary diagnosis, length of stay (LOS) and discharge setting were collected. WMM documentation and who provided WMM response were collected via EMR review. WMM documentation was qualitatively analyzed using constant comparative method to identify themes. Responses could fit multiple themes. 

Results: Of 87 patients with median(IQR) age 80(76-86) years, 59% were female, 49% had cognitive impairment and 2.3% were Hispanic or Latino. The most common primary diagnosis categories were infectious (24%), gastrointestinal (18%), and musculoskeletal/ trauma (15%). The median(IQR) LOS was 5(3-7) days, and 47% participants were discharged to a post-acute care facility. WMM responses were provided by patient (79%) or proxy (5.6%), or response provider could not be determined from the EMR (15%). Six themes were identified including getting home or disposition planning (43%), relationships (32%), function (31%), health (30%), comfort
(13%) and enjoying life (9%). 50.5% of patient responses captured multiple WMM themes.

Conclusions: In this cohort of older adults admitted to an ACE unit, WMM was documented despite high prevalence of cognitive impairment. WMM often included multiple themes, the most common were getting home or disposition planning. Future work towards ensuring goal-concordant care should validate and expand upon these
themes through patient interviews.​
Alexandra Petrakos, MD, assistant professor of Geriatrics.

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