Changes over Time in the Oregon Physician Orders for Life-Sustaining Treatment Registry

A Study of Two Decedent Cohorts

Dana Zive, Valerie M. Jimenez, Erik Fromme, Susan Tolle

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)500-507
Number of pages8
JournalJournal of palliative medicine
Volume22
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Registries
Physicians
Therapeutics
Logistic Models
Alzheimer Disease
Resuscitation Orders
Frail Elderly
Death Certificates
Sex Education
Cardiopulmonary Resuscitation
Cause of Death
Retrospective Studies
Demography

Keywords

  • advance care planning
  • frailty
  • POLST
  • resuscitation orders
  • serious illness

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

Cite this

Changes over Time in the Oregon Physician Orders for Life-Sustaining Treatment Registry : A Study of Two Decedent Cohorts. / Zive, Dana; Jimenez, Valerie M.; Fromme, Erik; Tolle, Susan.

In: Journal of palliative medicine, Vol. 22, No. 5, 01.05.2019, p. 500-507.

Research output: Contribution to journalArticle

@article{85febb9570a14994b126705c60214d36,
title = "Changes over Time in the Oregon Physician Orders for Life-Sustaining Treatment Registry: A Study of Two Decedent Cohorts",
abstract = "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.",
keywords = "advance care planning, frailty, POLST, resuscitation orders, serious illness",
author = "Dana Zive and Jimenez, {Valerie M.} and Erik Fromme and Susan Tolle",
year = "2019",
month = "5",
day = "1",
doi = "10.1089/jpm.2018.0446",
language = "English (US)",
volume = "22",
pages = "500--507",
journal = "Journal of Palliative Medicine",
issn = "1096-6218",
publisher = "Mary Ann Liebert Inc.",
number = "5",

}

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

AU - Jimenez, Valerie M.

AU - Fromme, Erik

AU - Tolle, Susan

PY - 2019/5/1

Y1 - 2019/5/1

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 - advance care planning

KW - frailty

KW - POLST

KW - resuscitation orders

KW - serious illness

UR - http://www.scopus.com/inward/record.url?scp=85060879927&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060879927&partnerID=8YFLogxK

U2 - 10.1089/jpm.2018.0446

DO - 10.1089/jpm.2018.0446

M3 - Article

VL - 22

SP - 500

EP - 507

JO - Journal of Palliative Medicine

JF - Journal of Palliative Medicine

SN - 1096-6218

IS - 5

ER -