Abstract
•Identify impact of POLST program usage, specifically different maturity status of the program and associated outcomes in nursing home residents, for short and long-stay residents.•Discuss predictors of nursing home deaths, classified by resident level and facility level predictors. The Physician Orders for Life-Sustaining Treatments (POLST) program was developed to enhance quality of care delivered at end-of-life (EoL). Although positive effects of POLST program use on dying individual's EoL care have been identified, the association between a state's POLST program maturity status and nursing home (NH) resident's place of death is unknown. Examine the impact of state-level POLST program maturity status on elderly NH residents' place of death. The POLST program data were linked to the following national-level datasets: Minimum Data Set 3.0, Vital Statistics Data, Medicare Chronic Conditions File, Certification and Survey Provider Enhanced Reports, and Area Health Resource File. Stratifying residents on long-stay and short-stay, we used descriptive statistics and multivariate logistic regression models to examine the impact of POLST maturity status on nursing home residents' place of death. Controlling for individual and contextual variables, long-stay residents living in states where the POLST program was mature had 20% increased odds of dying in NHs (OR: 1.20; CI 1.02-1.43) compared to those in states with non-conforming status. Residents in states with endorsed or developing POLST status also had greater odds of dying in NHs (OR: 1.09; CI 0.98-1.21 endorsed; OR: 1.12; CI 1.02-1.24 developing) compared to the residents in states with non-conforming status. No significant difference was noted for short-stay residents. Higher POLST maturity status was associated with greater likelihood of dying in NHs among long-stay nursing home residents. Our findings demonstrate that a well-structured advance care planning program such as POLST enhances care outcomes among elderly patients living in NHs.
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