{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:34:28Z","timestamp":1792787668196,"version":"4.5.0"},"reference-count":40,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"RWJF Harold Amos Medical Faculty Development Program"},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"crossref","award":["#R01AG070252-04S1"],"award-info":[{"award-number":["#R01AG070252-04S1"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"crossref","award":["#R01AG070252A"],"award-info":[{"award-number":["#R01AG070252A"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Betty Irene Moore Fellows for Nurse Leaders and Innovators"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>National guidelines recommend palliative care (PC) alongside life-sustaining treatment for older adults with severe trauma. However, outcomes associated with PC for these patients are not well-defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To determine frequency of inpatient PC process documentation in older adults with severe trauma and test associations with postdischarge health care utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective cohort study using electronic health record data linked to Medicare claims.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/Subjects:<\/jats:title>\n                    <jats:p>We included adults \u226566 years old admitted to a large, regional U.S. health care system with severe trauma (2016\u20132018) using consensus criteria for serious illness in trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>Natural language processing was used to measure documentation of five inpatient PC processes: code status limitations, goals-of-care (GOC) conversations, hospice discussions, PC consultations, and health care proxy designations. Associations between PC processes and postdischarge health care utilization were tested using multivariable regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 1267 admissions, the median age was 82 years (interquartile range [IQR] 75\u201388), and median injury severity score (0\u201375, higher is worse) was 16 (IQR 9\u201321); \u22651 PC process was documented in 81%. Among those surviving hospitalization (87%), one-year mortality was 26%. Documentation of \u22651 PC process was not significantly associated with differences in mean hospital days (16 vs. 19), home days (306 vs. 307), emergency department visits (2.3 vs. 2.2), or intensive care unit days (0.6 vs. 0.9) at one year. PC processes were significantly associated with subsequent hospice enrollment (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>PC was not associated with reduced health care utilization in older adults after trauma but was associated with one-year hospice enrollment. GOC conversations, specialty PC, and inpatient hospice discussions had low utilization, highlighting target areas for improvements in care delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10966218251405704","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T08:40:08Z","timestamp":1767084008000},"page":"495-502","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Natural Language Processing to Assess Palliative Care Processes and Health Care Utilization in Seriously Ill Older Adults with Severe Trauma"],"prefix":"10.1177","volume":"29","author":[{"given":"Daniel I.","family":"Hoffman","sequence":"first","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."},{"name":"Department of Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney","family":"Moore","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."},{"name":"Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyuan","family":"Ruan","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masami","family":"Tabata-Kelly","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."},{"name":"The Heller School for Social Policy &amp; Management, Brandeis University, Waltham, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Sciacca","sequence":"additional","affiliation":[{"name":"Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA."},{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamryn F.","family":"Gray","sequence":"additional","affiliation":[{"name":"Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA."},{"name":"Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA."},{"name":"School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."},{"name":"UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart R.","family":"Lipsitz","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."},{"name":"Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine S.","family":"Ritchie","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Division of Palliative Care &amp; Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA."},{"name":"Center for Optimal Aging &amp; Serious Illness Research, Massachusetts General Hospital, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotta","family":"Lindvall","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA."},{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zara","family":"Cooper","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."},{"name":"Department of Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."},{"name":"Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"Centers for Disease Control and Prevention. 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