000			03434nam a22005297a 4500
008			190724s20192019 xxu||||| |||| 00| 0 eng d
022			_a1932-6203
024			_a10.1371/journal.pone.0217113 [doi]
024			_aPMC6581427 [pmc]
024			_aPONE-D-19-09139 [pii]
040			_aOvid MEDLINE(R)
099			_a31211788
245			_aDemonstrating the impact of POLST forms on hospital care requires information not contained in state registries.
251			_aPLoS ONE [Electronic Resource]. 14(6):e0217113, 2019.
252			_aPLoS ONE. 14(6):e0217113, 2019.
253			_aPloS one
260			_c2019
260			_fFY2019
265			_sepublish
266			_d2019-07-24
501			_aAvailable online through MWHC library: 2006 - present
520			_aBACKGROUND: Physician Orders for Life-Sustaining Treatment (POLST) programs have expanded rapidly, but evaluating their impact on hospital care is challenging.
520			_aCONCLUSION: 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.
520			_aDESIGN: Prospective cohort study.
520			_aOBJECTIVES: 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.
520			_aRESULTS: 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).
520			_aSETTING 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.
546			_aEnglish
650			_a*Patient Care
650			_a*Physicians
650			_a*Resuscitation Orders
650			_aAged
650			_aCohort Studies
650			_aFemale
650			_aHumans
650			_aMale
650			_aMiddle Aged
650			_aPatient Admission/lj [Legislation & Jurisprudence]
650			_aPatient Admission/sn [Statistics & Numerical Data]
651			_aMedStar Washington Hospital Center
656			_aMedicine/Palliative Care
657			_aJournal Article
700			_aRao, Anirudh
790			_aNeedham DM, Ning X, Rao A, Tao JJ, Turnbull AE
856			_uhttps://dx.doi.org/10.1371/journal.pone.0217113 _zhttps://dx.doi.org/10.1371/journal.pone.0217113
942			_cART _dArticle
999			_c4477 _d4477