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

Mansi Agarwal,Jiyoun Song,Andrew W Dick,Patricia W Stone,Aluem Tark

doi:10.1177/1049909120956650

Abstract

The Physician Orders for Life-Sustaining Treatment (POLST) program was developed to enhance quality of care delivered at End-of-Life (EoL). Although positive impacts of the POLST program have been identified, the association between a program maturity status and nursing home resident's likelihood of dying in their current care settings remain unanswered. This study aims to evaluate the impact of the POLST program maturity status on nursing home residents' place of death. Using multiple national-level datasets, we examined total 595,152 residents and their place of death. The result showed that the long-stay residents living in states where the program was mature status had 12% increased odds of dying in nursing homes compared that of non-conforming status. Individuals residing in states with developing program status showed 11% increase in odds of dying in nursing homes. The findings demonstrate that a well-structured and well-disseminated POLST program, combined with a continued effort to meet high standards of quality EoL care, can bring out positive health outcomes for elderly patients residing in care settings.

Highlights

Over 16,000 U.S nursing homes (NHs) serve nearly 1.5 million U.S individuals at any time.[1]
Controlling for individual and contextual variables, long-stay nursing home residents living in states where the program was mature status had 20% increased odds of dying in nursing homes (OR: 1.20; confidence intervals (CI) 1.02-1.43) compared to those who resided in states with non-conforming status
Mature and developing maturity status were associated with greater likelihood of dying in nursing homes among long-stay residents

Summary

Introduction

Over 16,000 U.S nursing homes (NHs) serve nearly 1.5 million U.S individuals at any time.[1]. The Physician Orders for Life-Sustaining Treatment (POLST) program is an advance care planning paradigm developed by medical experts in Oregon.[28] As a voluntary tool, acknowledged as a program to help achieve high quality EoL care, it aims to facilitate EoL care discussions between a healthcare provider and a dying patients.[29,30,31,32,33]. While the use of POLST program was positively associated with increased hospice referrals,(35, 36) and EoL care discussions,(37–40) an association between a state’s POLST program maturity status and NH residents outcomes is unclear. Positive impacts of the Physician Orders for LifeSustaining Treatment Program use have been identified, the association between a state’s program maturity status and nursing home resident’s likelihood of dying in their current care settings, nursing homes, remain unanswered

Results

Discussion

Conclusion