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1. Understand the impact over time of the POLST program on the place of death of nursing home residents
2. Discuss how specific advance directive policies impact decision making at the end of life for nursing home residents
Physician Orders for Life-Sustaining Treatment (POLST) programs assist patients, surrogates, and clinicians in ensuring that preferences for treatment at the end of life are prioritized.
To examine the impact of the POLST program on place of death of nursing home (NH) residents over time (e.g., NH or hospice) based on developing or endorsed status (e.g., developing meaning beginning of use; endorsed meaning that benchmarks in use among institutions within a state were established).
This event time model study examined the associations between POLST status and the probability of dying in a NH or hospice. A national 10% sample of NH decedents between 2012 and 2018 was created. We merged data on the POLST year of development or endorsement with the 10% sample of quarterly assessments and place of death from the Minimum Data Set 3.0 and the National Vital Statistics mortality data for U.S. NH residents aged 65 and older.
Our findings represent 225,149 NH residents. Two thirds (67%) were women, and the majority were White (82.2%). Five years after POLST development, the probability of dying in an NH or hospice was statistically significantly (5.6 percentage points, or 7.5%) higher compared to the NH or hospice death in the year prior to POLST development. The probability of dying in an NH or hospice also showed sustained increase with endorsement and maturity status of the POLST program over time.
The POLST program has potential to improve end-of-life care for NH residents with continued proliferation of programs within states. More research is needed to examine the impact for racial and ethnic minority NH residents.
Advance directives programs can be helpful in ensuring that NH residents can die in place or in hospice should they desire, potentially avoiding often unnecessary and aggressive care during hospitalizations.
© 2022 Published by Elsevier Inc.