Care preferences in physician orders for life sustaining treatment in California nursing homes.
Care preferences in physician orders for life sustaining treatment in California nursing homes.
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DOI：
10.1111/jgs.17737
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发表时间：
2022-07
影响因子：
6.3
通讯作者：
Zingmond D
中科院分区：
文献类型：
--
作者：
Jennings LA;Wenger NS;Liang LJ;Parikh P;Powell D;Escarce JJ;Zingmond D
维持生命治疗医嘱（POLST）促进了患者维持生命治疗医嘱在各个护理机构之间的记录和转换。对于POLST中与护理偏好相关的患者和设施因素，我们所知甚少。我们描述了2011年至2016年加利福尼亚州所有养老院（NH）居民的POLST订单。加州要求NHs在最低数据集中记录居民是否完成POLST和POLST内的订单。使用每年的连续横断面设计，我们描述了2011年至2016年所有加州NH居民的POLST完成情况和订单（N=1,112,668）。我们使用logistic混合效应回归模型来估计POLST完成和复苏订单，以了解与居民和设施特征的关系，包括医疗保险和医疗补助服务中心（CMS）养老院比较总体五星质量评级。POLST完成率从2011年到2016年显著增加，2016年大多数居民都有POLST（短期居留：68%；长期居留：81%）。在2016年有POLST的居民中，54%的长期居住居民和41%的短期居住居民有DNR订单。在无预后的居民中，约有90%的人接受过有限的医疗干预或舒适措施。少数居民（<6%）的POLST有矛盾的命令。在回归分析中，功能依赖程度越高的居民POLST完成度越高，而认知障碍程度越高的居民POLST完成度越低。更大的功能和认知障碍与DNR命令有关。种族和少数民族表现出更积极的护理偏好。较高的CMS五星级设施质量评级与较高的POLST完成度相关。在国家授权在NHs中记录POLST完成情况六年后，大多数加州NH居民都有POLST，大约一半的长期居民被命令限制维持生命的治疗。未来的工作应侧重于确定POLST中记录的护理偏好决定的质量。
Physician Orders for Life-Sustaining Treatment (POLST) facilitates documentation and transition of patients’ life-sustaining treatment orders across care settings. Little is known about patient and facility factors related to care preferences within POLST across a large, diverse nursing home population. We describe the orders within POLST among all nursing home (NH) residents in California from 2011 to 2016. California requires NHs to document in the Minimum Data Set whether residents complete a POLST and orders within POLST. Using a serial cross-sectional design for each year, we describe POLST completion and orders for all California NH residents from 2011 to 2016 (N=1,112,668). We used logistic mixed-effects regression models to estimate POLST completion and resuscitation orders to understand the relationship with resident and facility characteristics, including Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare overall five-star quality rating. POLST completion significantly increased from 2011 to 2016 with most residents having a POLST in 2016 (short-stay:68%; long-stay:81%). Among those with a POLST in 2016, 54% of long-stay and 41% of short-stay residents had a DNR order. Among residents with DNR, >90% had orders for limited medical interventions or comfort measures. Few residents (<6%) had a POLST with contradictory orders. In regression analyses, POLST completion was greater among residents with more functional dependence, but was lower among those with more cognitive impairment. Greater functional and cognitive impairment were associated with DNR orders. Racial and ethnic minorities indicated more aggressive care preferences. Higher CMS five-star facility quality rating was associated with greater POLST completion. Six years after a state mandate to document POLST completion in NHs, most California NH residents have a POLST, and about half of long-stay residents have orders to limit life-sustaining treatment. Future work should focus on determining the quality of care preference decisions documented in POLST.
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影响因子：
6.5
作者：
Schmidt, Terri A.;Zive, Dana;Tolle, Susan W.
通讯作者：
Tolle, Susan W.
影响因子：
2.8
作者：
Tark, Aluem;Agarwal, Mansi;Stone, Patricia W.
通讯作者：
Stone, Patricia W.
影响因子：
2.8
作者：
Rahman, Anna N.;Bressette, Matthew;Enguidanos, Susan
通讯作者：
Enguidanos, Susan
影响因子：
3
作者：
Thomas KS;Dosa D;Wysocki A;Mor V
通讯作者：
Mor V
DOI：
10.1093/gerona/54.11.m546
发表时间：
1999-11-01
影响因子：
5.1
作者：
Morris, JN;Fries, BE;Morris, SA
通讯作者：
Morris, SA