TY  - BOOK
AU  - Rao, Anirudh
TI  - Demonstrating the impact of POLST forms on hospital care requires information not contained in state registries
SN  - 1932-6203
PY  - 2019///
KW  - *Patient Care
KW  - *Physicians
KW  - *Resuscitation Orders
KW  - Aged
KW  - Cohort Studies
KW  - Female
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Patient Admission/lj [Legislation & Jurisprudence]
KW  - Patient Admission/sn [Statistics & Numerical Data]
KW  - MedStar Washington Hospital Center
KW  - Medicine/Palliative Care
KW  - Journal Article
N1  - Available online through MWHC library: 2006 - present
N2  - BACKGROUND: Physician Orders for Life-Sustaining Treatment (POLST) programs have expanded rapidly, but evaluating their impact on hospital care is challenging; CONCLUSION: Among patients who wanted to avoid intubation and/or CPR, MOLST forms were protective when the patient was unaccompanied by a healthcare proxy at admission and could not communicate. Fewer than 10% of patients met these criteria during unplanned readmissions, and state registry data does not allow this sub-population to be identified; DESIGN: Prospective cohort study; OBJECTIVES: To demonstrate how careful study design can reveal POLST's impact at hospital admission and why analyses of state registry data are unlikely to capture POLST's effects; RESULTS: Among 1,507 patients with DNR/I orders at discharge, 124 (8%) had unplanned readmissions, 112 (90%) could communicate or were accompanied by a proxy at readmission, and 12 (10%) could not communicate and were unaccompanied. For patients who were unaccompanied and could not communicate, MOLST significantly decreased the median time from readmission to DNR/I order (1.2 vs 27.1 hours, P = .001), but this association was greatly attenuated among patients who could communicate or were accompanied by a proxy (16.4 vs 25.4 hours P = .10); SETTING AND PARTICIPANTS: Adult in-patients with Do Not Intubate and/or Do Not Resuscitate (DNR/I) orders in the electronic medical record at the time of discharge from Johns Hopkins Hospital over 18 months. For patients with unplanned readmissions within 30 days, records were reviewed to determine if a Maryland Medical Order for Life-Sustaining Treatment (MOLST) form was presented and for the time from readmission to a DNR/I order in the EMR. Analyses were stratified by whether patients could communicate or were accompanied by a proxy at readmission
UR  - https://dx.doi.org/10.1371/journal.pone.0217113
ER  -