Relationship of POLST to Hospitalization and ICU Care Among Nursing Home Residents in California.
Relationship of POLST to Hospitalization and ICU Care Among Nursing Home Residents in California.
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DOI：
10.1007/s11606-023-08357-3
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发表时间：
2023-12
影响因子：
5.7
通讯作者：
Wenger, Neil S.
中科院分区：
文献类型：
--
作者：
Zingmond, David;Powell, David;Jennings, Lee A.;Escarce, Jose J.;Liang, Li-Jung;Parikh, Punam;Wenger, Neil S.
生命维持治疗医嘱（POLST）记录了基于患者护理偏好的护理强度说明。POLST表格通常反映了患者的意愿，并规定了随后的医疗护理，但目前尚不清楚POLST在养老院居民中的使用和内容如何与大量人群中的住院利用率相关。评估加州疗养院居民POLST使用和内容与医院利用之间的关系。回顾性队列研究，使用与加州S部分（POLST文件）、Medicare受益人摘要文件和Medicare行项目索赔相关的最小数据集。加州养老院居民与医疗保险收费服务保险，2011-2016年。根据住院医师和疗养院特征调整后的住院、住院天数和重症监护室（ICU）天数。1，112，834名居民完成并签署了（有效）POLST，其中包含29.6%的居民时间（人年）的全面治疗CPR订单和27.1%的居民时间的选择性治疗或舒适护理的DNR订单。未签名的POLST占住院时间的11.3%。居民经历了14次住院治疗，平均每100人年120个住院日和37个ICU日。具有POLST的居民表明CPR完全治疗的利用率与没有POLST的居民几乎相同。利用率下降的梯度与较低的护理强度有关。与没有POLST的居民相比，POLST表明DNR舒适护理的居民每100人年在医院的时间减少了56天，在ICU的时间减少了22天。未签名的POLST与医院利用率的关系较弱且不一致。在加州NH居民中，POLST中的护理偏好强度与医院利用率之间存在直接关系。这些研究结果强调了一个有效的POLST捕获知情的喜好养老院居民的重要性。
Physician Orders for Life Sustaining Treatment (POLST) document instructions for intensity of care based upon patient care preferences. POLST forms generally reflect patients’ wishes and dictate subsequent medical care, but it is not known how POLST use and content among nursing home residents is associated with inpatient utilization across a large population. Evaluate the relationship between POLST use and content with hospital utilization among nursing home residents in California. Retrospective cohort study using the Minimum Data Set linked to California Section S (POLST documentation), the Medicare Beneficiary Summary File, and Medicare line item claims. California nursing home residents with Medicare fee-for-service insurance, 2011–2016. Hospitalization, days in the hospital, and days in the intensive care unit (ICU) after adjustment for resident and nursing home characteristics. The 1,112,834 residents had a completed and signed (valid) POLST containing orders for CPR with Full treatment 29.6% of resident-time (in person-years) and a DNR order with Selective treatment or Comfort care 27.1% of resident-time. Unsigned POLSTs accounted for 11.3% of resident-time. Residents experienced 14 hospitalizations and a mean of 120 hospital days and 37 ICU days per 100 person-years. Residents with a POLST indicating CPR Full treatment had utilization nearly identical to residents without a POLST. A gradient of decreased utilization was related to lower intensity of care orders. Compared to residents without a POLST, residents with a POLST indicating DNR Comfort care spent 56 fewer days in the hospital and 22 fewer days in the ICU per 100 person-years. Unsigned POLST had a weaker and less consistent relationship with hospital utilization. Among California NH residents, there is a direct relationship between intensity of care preferences in POLST and hospital utilization. These findings emphasize the importance of a valid POLST capturing informed preferences for nursing home residents.
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