Impact of Physician Orders for Life-Sustaining Treatment (POLST) Program Maturity Status on the U.S. Nursing Home Resident's Place of Death (TH311D)

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.