Variations in Physician Orders for Life-Sustaining Treatment Program across the Nation: Environmental Scan
Variations in Physician Orders for Life-Sustaining Treatment Program across the Nation: Environmental Scan
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DOI：
10.1089/jpm.2018.0626
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发表时间：
2019-02-21
影响因子：
2.8
通讯作者：
Stone, Patricia W.
中科院分区：
文献类型：
--
作者：
Tark, Aluem;Agarwal, Mansi;Stone, Patricia W.
工作背景：生命维持治疗医嘱（POLST）是一种先进的护理计划工具，旨在记录预期寿命有限的人的临终（EoL）护理愿望。虽然已经研究了POLST计划的积极影响，但全国各州具体的POLST计划的变化仍然未知。目标：识别POLST表单中的状态变化，并确定变化是否与程序成熟度状态相关。设计：环境扫描。测量：使用国家POLST网站，国家特定的POLST程序的特点进行了检查。使用可用的POLST表格样本，提取EoL护理选项。结果如下：在所有51个州（美国50个州和华盛顿特区）中，大多数（n = 48，98%）积极参与POLST; 3个州（5.9%）处于成熟状态，19个州和哥伦比亚特区（39.2%）获得认可，24个州处于发展阶段（47.1%），4个州（7.8%）处于不成熟状态。45个州（88.2%）有表格可供审查。分别在32份（71.1%）和33份（73.3%）POLST表格中确定了抗生素和静脉输液选项。各种形式都提到了医院转移和氧气的使用。使用呼吸装置（即，持续气道正压通气和双水平气道正压通气）在27份（60%）表格中提及，而呼吸机或插管的使用在36份POLST表格中提及（80%）。POLST成熟状态和提供治疗方案之间没有发现关联。结论：确定了感染和症状管理方案整合的变化。需要进一步研究，以确定是否存在与POLST表格上提供治疗方案相关的区域因素，以及报告的实际感染率或症状是否存在差异。
Background: Physician Orders for Life-Sustaining Treatment (POLST) is an advance care planning tool that is designed to document end-of-life (EoL) care wishes of those living with limited life expectancies. Although positive impacts of POLST program has been studied, variations in state-specific POLST programs across the nation remain unknown. Objective: Identify state variations in POLST forms and determine if variations are associated with program maturity status. Design: Environmental scan. Measurements: Using the national POLST website, state-specific POLST program characteristics were examined. With available sample POLST forms, EoL care options were abstracted. Results: Of all 51 states (50 United States states and Washington, D.C examined), the majority (n = 48, 98%) were actively participating in POLST; 3 states (5.9%) had Mature status, 19 states and District of Columbia (39.2%) were Endorsed, 24 states were in the developing phase (47.1%), and 4 states (7.8%) were nonconforming. Forty-five states (88.2%) had forms available for review. Antibiotic and intravenous fluid options were identified in 32 (71.1%), and 33 (73.3%) POLST forms, respectively. Hospital transfer and use of oxygen were mentioned in all forms. Use of respiratory devices (i.e., continuous positive airway pressure and bi-level positive airway pressure) were mentioned on 27 (60%) forms, whereas ventilator or intubation use were mentioned in 36 POLST forms (80%). No associations were found between POLST maturity status and provision of treatment options. Conclusions: Variations in integration of infection and symptom management options were identified. Further research is needed to determine if there are regional factors associated with provision of treatment options on POLST forms and if there are differences in actual rates of infection or symptoms reported.