Abstract:
BACKGROUND:Decisions to limit use of life-sustaining treatment occur frequently during hospitalizations, and portable medical orders (also known as Portable Orders for Life-Sustaining Treatment (POLST)) can ensure that patient preferences regarding resuscitation are followed after discharge. OBJECTIVE:To determine the frequency and predictors of completion of POLST orders for adults with change during hospitalization in resuscitation status to Do Not Resuscitate. DESIGN:Retrospective observational study at level 1 trauma and academic hospital in Minneapolis, MN, USA PARTICIPANTS: All adults (18 years or older) hospitalized between June 2017 and June 2018, inclusive, with code status changed from Full Code to DNR. For patients with more than one hospitalization during this study interval, only the first hospitalization when DNR was ordered was included in this analysis. MAIN MEASURES:Completion of POLST orders by time of discharge. KEY RESULTS:From 2017 to 2018, 160 adults had a change from Full Code to DNR status during index hospitalization and survived to discharge, most (156 patients) to a nursing care facility. Of these, only 50 (31.2%) had POLST orders provided at discharge. Documentation of informed refusal of intubation in addition to DNR status was a significant predictor (OR 4.1, 99% CI 1.5-11.0) of POLST orders on discharge, as was admission to a medical service compared with non-medical service (OR 3.2, 99% CI 1.1-12.2). Palliative care consultants, rather than primary providers on the hospital services, completed most POLST orders. CONCLUSIONS:Despite primary hospital providers engaging in conversations regarding resuscitation and entering DNR orders during hospitalization, the majority of patients in our study discharged to other care facilities without POLST orders. POLST orders are a simple palliative care tool available to primary hospital providers to help ensure continuity of plan of care at discharge for patients who wish to avoid invasive life-sustaining treatments and/or cardiopulmonary resuscitation.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Rubins JBdoi
10.1007/s11606-020-05698-1subject
Has Abstractpub_date
2020-07-01 00:00:00pages
2065-2068issue
7eissn
0884-8734issn
1525-1497pii
10.1007/s11606-020-05698-1journal_volume
35pub_type
杂志文章abstract:BACKGROUND:Inadequate health literacy is prevalent among seniors and is associated with poor health outcomes. At hospital discharge, medications are frequently changed and patients are informed of these changes via their discharge instructions. OBJECTIVES:Explore the association between health literacy and medication ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-011-1886-3
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abstract:BACKGROUND:Hemophilia A is a rare, sex-linked genetic disorder treated with intravenous administration of factor VIII (FVIII) to prevent bleeding; however, approaches vary across and within countries. Value-of-information (VOI) methods identify situations in which the cost-benefit evidence is sufficient to adopt one tr...
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abstract:BACKGROUND:Network meta-analysis (NMA) is a popular tool to compare multiple treatments in medical research. It is frequently implemented via Bayesian methods. The prior choice of between-study heterogeneity is critical in Bayesian NMAs. This study evaluates the impact of different priors for heterogeneity on NMA resul...
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doi:10.1007/s11606-015-3558-1
更新日期:2016-04-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4312-2
更新日期:2018-05-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1525-1497.2005.30145.x
更新日期:2005-04-01 00:00:00
abstract::Research into health literacy and shared decision-making has largely developed along parallel, but distinct lines over the past two decades. There is little evidence that the concepts and related practice have intersected except in the most functional way, for example, to simplify shared decision-making tools by impro...
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更新日期:2020-05-29 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
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更新日期:2009-05-01 00:00:00
abstract:BACKGROUND:Marijuana is currently legal for recreational use in 10 states and Washington DC while a total of 34 states have implemented varying degrees of medical marijuana. The commercialization of marijuana has been accompanied by a proliferation of false claims regarding the therapeutic potential of marijuana, which...
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pub_type: 杂志文章
doi:10.1007/s11606-019-05335-6
更新日期:2020-01-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2001-07-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2007-07-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:1990-09-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1046/j.1525-1497.2003.20114.x
更新日期:2003-01-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Veterans commonly receive care from both Veterans Health Administration (VA) and non-VA sources (i.e., dual use). A major challenge in comparing health outcomes between dual users and VA-predominant users is applying an accurate method of risk adjustment. OBJECTIVE:To determine how different comorbidity ind...
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更新日期:2017-09-01 00:00:00
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更新日期:2008-12-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2011-10-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
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更新日期:2014-01-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2002-06-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
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更新日期:1986-11-01 00:00:00