Yale New Haven (Conn.) Health raised hospice consultation rates from 44% to 84% by redesigning its EHR to automatically link hospice consultation orders to comfort measures orders, according to a study published in JAMA Network Open.
The study tracked more than 14,600 hospitalized patients across Yale New Haven’s seven-campus academic health system over four years. Before the change, clinicians had to place separate orders for hospice consultation and comfort measures. The redesign made hospice consultation the default, opt-out choice whenever a clinician ordered comfort measures.
Hospice disposition rates rose from 37% to 56% after the change took effect, and inpatient deaths among comfort measures patients who did not enroll in hospice fell by 16 percentage points. By fiscal year 2025, hospice consultation rates topped 80% across all racial and ethnic groups studied, including Asian, Hispanic, non-Hispanic Black and non-Hispanic White patients, narrowing longstanding gaps in hospice access.
“Healthcare systems often focus on education alone to change behavior, but this study highlights the power of making the right action the easier action,” said study co-author Nancy Kim, MD, PhD, senior medical director of Care Signature for Yale New Haven Health and associate clinical professor of General Internal Medicine at Yale School of Medicine, in an Aug. 26 news release shared with Becker’s.
Study co-author L. Scott Sussman, MD, physician executive director in the Office of the Chief Medical Officer for Yale New Haven Hospital, said the goal is not to steer patients toward a particular decision but to ensure they have the information needed to make choices aligned with their values.
The findings add to evidence that EHR-based defaults can scale evidence-based practices in high-stakes, time-sensitive settings such as end-of-life care.
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