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Medline ® Abstract for Reference 73

of 'Palliative care: Nursing home'

73
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Use of the Physician Orders for Life-Sustaining Treatment among California Nursing Home Residents.
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Jennings LA, Zingmond D, Louie R, Tseng CH, Thomas J, O'Malley K, Wenger NS
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J Gen Intern Med. 2016;31(10):1119. Epub 2016 May 17.
 
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.
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David Geffen School of Medicine at UCLA, Division of Geriatrics, 10945 Le Conte Ave., Suite 2339, Los Angeles, CA, 90095-1687, USA. lajennings@mednet.ucla.edu.
PMID