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Use of the Physician Orders for Life-Sustaining Treatment among California Nursing Home Residents.

Abstract：

BACKGROUND:Physician Orders for Life-Sustaining Treatment (POLST) is a tool that facilitates the elicitation and continuity of life-sustaining care preferences. POLST was implemented in California in 2009, but how well it disseminated across a large, racially diverse population is not known and has implications for end-of-life care. OBJECTIVE:To evaluate the use of POLST among California nursing home residents, including variation by resident characteristics and by nursing home facility. DESIGN:Observational study using California Minimum Data Set Section S. PARTICIPANTS:A total of 296,276 people with a stay in 1,220 California nursing homes in 2011. MAIN MEASURES:The proportion of residents with a completed POLST (containing a resuscitation status order and resident/proxy and physician signatures) and relationship to resident characteristics; change in POLST use during 2011; and POLST completion and unsigned forms within nursing homes. KEY RESULTS:During 2011, POLST completion increased from 33 to 49 % of California nursing home residents. Adjusting for age and gender using a mixed-effects logistic model, long-stay residents were more likely than short-stay residents to have a completed POLST [OR = 2.36 (95 % CI 2.30, 2.42)]; severely cognitively impaired residents were less likely than unimpaired to have a completed POLST [OR = 0.89 (95 % CI 0.87, 0.92)]; and there was little difference by functional status. There was no difference in POLST completion among White non-Hispanic, Black, and Hispanic residents. Variation in POLST completion among nursing homes far exceeded that attributable to resident characteristics with 40 % of facilities having ≥80 % of long-stay residents with a completed POLST, while 20 % of facilities had ≤10 % of long-stay residents with a completed POLST. Thirteen percent of nursing home residents had a POLST containing a resuscitation preference but lacked a signature, rendering the POLST invalid. CONCLUSIONS:Statewide nursing home data show broad uptake of POLST in California without racial disparity. However, variation in POLST completion among nursing homes identifies potential areas for quality improvement.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Jennings LA,Zingmond D,Louie R,Tseng CH,Thomas J,O'Malley K,Wenger NS

doi

10.1007/s11606-016-3728-9

subject

Has Abstract

pub_date

2016-10-01 00:00:00

pages

1119-26

issue

eissn

0884-8734

issn

1525-1497

pii

10.1007/s11606-016-3728-9

journal_volume

pub_type

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Use of the Physician Orders for Life-Sustaining Treatment among California Nursing Home Residents.