Association Between Physician Orders for Life-Sustaining Treatment for Scope of Treatment and In-Hospital Death in Oregon
Association Between Physician Orders for Life-Sustaining Treatment for Scope of Treatment and In-Hospital Death in Oregon
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DOI：
10.1111/jgs.12889
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发表时间：
2014-07-01
影响因子：
6.3
通讯作者：
Tolle, Susan W.
中科院分区：
文献类型：
--
作者：
Fromme, Erik K.;Zive, Dana;Tolle, Susan W.
目的：研究生命维持治疗医嘱（POLST）的治疗范围和死亡时的护理设置之间的关系。设计：横断面。设置：俄勒冈州在2010年和2011年。参与者：自然原因死亡的人。测量：俄勒冈州死亡记录包含死亡原因和死亡地点与POLST订单匹配的人在俄勒冈州POLST登记表。Logistic回归被用来衡量POLST顺序和死亡地点之间的关联。结果：在58,000名死者中，17,902人（30.9%）在登记处有POLST表。他们的治疗范围顺序是仅舒适措施，11，836（66.1%）;有限干预，4，787（26.7%）;全面治疗，1，153（6.4%）。仅舒适措施（CMO）订单建议避免住院，除非在当前环境下无法实现舒适; 6.4%的POLST CMO订单参与者在医院死亡，相比之下，44.2%的订单进行全面治疗，34.2%的注册表中没有POLST表格。在逻辑回归中，那些接受有限干预的人在医院死亡的几率是3.97倍（95%CI = 3.59-4.39），而那些接受全面治疗的患者的几率是接受全面治疗的患者的9.66倍（95%CI = 8.39-11.13）.结论：与医院死亡人数的相关性表明，那些希望避免住院的人的临终偏好得到了尊重，如POLST命令中所记录的那样。
OBJECTIVES: To examine the relationship between Physician Orders for Life-Sustaining Treatment (POLST) for Scope of Treatment and setting of care at time of death.DESIGN: Cross-sectional.SETTING: Oregon in 2010 and 2011.PARTICIPANTS: People who died of natural causes.MEASUREMENTS: Oregon death records containing cause and location of death were matched with POLST orders for people with a POLST form in the Oregon POLST registry. Logistic regression was used to measure the association between POLST orders and location of death.RESULTS: Of 58,000 decedents, 17,902 (30.9%) had a POLST form in the registry. Their orders for Scope of Treatment were comfort measure only, 11,836 (66.1%); limited interventions, 4,787 (26.7%); and full treatment, 1,153 (6.4%). Comfort measures only (CMO) orders advise avoiding hospitalization unless comfort cannot be achieved in the current setting; 6.4% of participants with POLST CMO orders died in the hospital, compared with 44.2% of those with orders for full treatment and 34.2% for those with no POLST form in the registry. In the logistic regression, the odds of dying in the hospital of those with an order for limited interventions was 3.97 times as great (95% CI = 3.59-4.39) as of those with a CMO order, and the odds of those with an order for full treatment was 9.66 times as great (95% CI = 8.39-11.13).CONCLUSIONS: The association with numbers of deaths in the hospital suggests that end-of-life preferences of people who wish to avoid hospitalization as documented in POLST orders are honored.