TY - JOUR
T1 - Changes over Time in the Oregon Physician Orders for Life-Sustaining Treatment Registry
T2 - A Study of Two Decedent Cohorts
AU - Zive, Dana M.
AU - Jimenez, Valerie M.
AU - Fromme, Erik K.
AU - Tolle, Susan W.
N1 - Funding Information:
Ms. D.M.Z. reports grant support from The Denison Family Fund of the Oregon Community Foundation. Ms. D.M.Z also receives salary support from the Oregon POLST Registry, which operates at OHSU under contract with the Oregon Health Authority. Ms. V.M.J. receives salary support from the OHSU Center for Ethics in Health Care. The OHSU Center for Ethics in Health Care administers the Oregon POLST Program. Dr. E.K.F. reports grants from The Gordon and Betty Moore Foundation and The John A. Hartford Foundation. Dr. S.W.T. reports grants from The Kinsman Foundation and The Denison Family Fund of the Oregon Community Foundation and receives salary support from the OHSU Center for Ethics in Health Care. The OHSU Center for Ethics is supported by private philanthropy and does not accept gifts from health care industry sources.
Funding Information:
This study was supported by a grant from The Denison Family Fund of the Oregon Community Foundation.
Publisher Copyright:
© Dana M. Zive et al., 2019; Published by Mary Ann Liebert, Inc. 2019.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/5
Y1 - 2019/5
N2 - Background: The Physician Orders for Life-Sustaining Treatment (POLST) began in Oregon in 1993 and has since spread nationally and internationally. Objectives: Describe and compare demographics and POLST orders in two decedent cohorts: deaths in 2010-2011 (Cohort 1) and in 2015-2016 (Cohort 2). Design: Descriptive retrospective study. Setting/Subjects: Oregon decedents with an active form in the Oregon POLST Registry. Measurements: Oregon death records were matched with POLST orders. Descriptive analysis and logistic regression models assess differences between the cohorts. Results: The proportion of Oregon decedents with a registered POLST increased by 46.6% from 30.9% (17,902/58,000) in Cohort 1 to 45.3% (29,694/65,458) in Cohort 2. The largest increase (83.3%) was seen in decedents 95 years or older with a corresponding 78.7% increase in those with Alzheimer's disease and dementia, while the interval between POLST form completion and death in these decedents increased from a median of 9-52 weeks. Although orders for do not resuscitate and other orders to limit treatment remained the most prevalent in both cohorts, logistic regression models confirm a nearly twofold increase in odds for cardiopulmonary resuscitation and full treatment orders in Cohort 2 when controlling for age, sex, race, education, and cause of death. Conclusion: Compared with Cohort 1, Cohort 2 reflected several trends: a 46.6% increase in POLST Registry utilization most marked in the oldest old, substantial increases in time from POLST completion to death, and disproportionate increases in orders for more aggressive life-sustaining treatment. Based on these findings, we recommend testing new criteria for POLST completion in frail elders.
AB - Background: The Physician Orders for Life-Sustaining Treatment (POLST) began in Oregon in 1993 and has since spread nationally and internationally. Objectives: Describe and compare demographics and POLST orders in two decedent cohorts: deaths in 2010-2011 (Cohort 1) and in 2015-2016 (Cohort 2). Design: Descriptive retrospective study. Setting/Subjects: Oregon decedents with an active form in the Oregon POLST Registry. Measurements: Oregon death records were matched with POLST orders. Descriptive analysis and logistic regression models assess differences between the cohorts. Results: The proportion of Oregon decedents with a registered POLST increased by 46.6% from 30.9% (17,902/58,000) in Cohort 1 to 45.3% (29,694/65,458) in Cohort 2. The largest increase (83.3%) was seen in decedents 95 years or older with a corresponding 78.7% increase in those with Alzheimer's disease and dementia, while the interval between POLST form completion and death in these decedents increased from a median of 9-52 weeks. Although orders for do not resuscitate and other orders to limit treatment remained the most prevalent in both cohorts, logistic regression models confirm a nearly twofold increase in odds for cardiopulmonary resuscitation and full treatment orders in Cohort 2 when controlling for age, sex, race, education, and cause of death. Conclusion: Compared with Cohort 1, Cohort 2 reflected several trends: a 46.6% increase in POLST Registry utilization most marked in the oldest old, substantial increases in time from POLST completion to death, and disproportionate increases in orders for more aggressive life-sustaining treatment. Based on these findings, we recommend testing new criteria for POLST completion in frail elders.
KW - POLST
KW - advance care planning
KW - frailty
KW - resuscitation orders
KW - serious illness
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U2 - 10.1089/jpm.2018.0446
DO - 10.1089/jpm.2018.0446
M3 - Article
C2 - 30484728
AN - SCOPUS:85060879927
VL - 22
SP - 500
EP - 507
JO - Journal of Palliative Medicine
JF - Journal of Palliative Medicine
SN - 1096-6218
IS - 5
ER -