Association of Timely Goals of Care Discussions with Hospitalizations Due to Infections in Nursing Homes

Background: Hospitalizations from infections are common among nursing home (NH) residents and can lead to burdensome treatments that may not align with residents’ preferences for care. Although goals of care discussions can ensure that residents’ wishes are honored, little is known about the impact of timely discussions on residents’ infection outcomes. Objectives: To determine the association between timely goals of care (TGOC) discussions and infection-related hospitalizations among NH residents. Design: Retrospective cross-sectional analysis. Setting/Subjects: The sample consisted of 892 NHs who participated in a 2018 national survey in the United States that included a TGOC index. Measurements: A facility-level TGOC index (scored 0–18) was categorized into two levels (0–5, 6–18). Hospitalizations from infections were identified using CMS claims data. Multivariable logistic regression was used to examine the association between infection-related hospitalization and TGOC intensity. Results: A total of 867 NHs with 988,502 resident observations were analyzed. The mean TGOC index was 13.6 (SD = 5.1); about 10% fell in the lower TGOC category (0–5). Residents were, on average, 82 (SD = 9) years old; mostly female (63.9%), and White (84.6%). In fully adjusted models, residents in facilities with higher TGOC engagement (scores 6–18) had lower odds of infection-related hospitalization compared to those in facilities with lower engagement (scores 0–5) (AOR 0.84, 95% CI: 0.72–0.99, p < 0.05). Sensitivity analyses using the original four-level TGOC index produced consistent results. Conclusions: TGOC discussions are associated with reduced infection-related hospitalizations in NHs. Future research should examine how facility policies and staff training shape TGOC implementation.