Injured Older Adults Transported by Emergency Medical Services

One Year Outcomes by POLST Status

Research output: Contribution to journalArticle

Abstract

Background: Advance care planning documents, including Physician Orders for Life-Sustaining Treatment (POLST), are intended to guide care near end of life, particularly in emergency situations. Yet, research on POLST during emergency care is sparse. Methods: A total of 7,055 injured patients age ≥ 65 years were transported by 8 emergency medical services (EMS) agencies to 23 hospitals in Oregon. We linked multiple data sources to EMS records, including: the Oregon POLST Registry, Medicare claims data, Oregon Trauma Registry, Oregon statewide inpatient data, and Oregon vital statistics records. We describe patient and event characteristics by POLST status at time of 9-1-1 contact, subsequent changes in POLST forms, and mortality to 12 months. Results: Of 7,055 injured older adults, 1,412 (20.0%) had a registered POLST form at the time of 911 contact. Among the 1,412 POLST forms, 390 (27.6%) specified full orders, 585 (41.4%) limited interventions, and 437 (30.9%) comfort measures only. By one year, 2,471 (35%) patients had completed POLST forms. Among the 4 groups (no POLST, POLST-full orders, POLST-limited intervention, POLST-comfort measures), Injury Severity Scores were similar. Mortality differences were present by 30 days (5.0%, 4.6%, 8.0%, and 13.3%, p < 0.01) and were greater by one year (19.5%, 23.9%, 35.4%, and 46.2%, p < 0.01). Conclusions: Among injured older adults transported by ambulance in Oregon, one in 5 had an active POLST form at the time of 9-1-1 contact, the prevalence of which increased over the following year. Mortality differences by POLST status were evident at 30 days and large by one year. This information could help emergency, trauma, surgical, inpatient, and outpatient clinicians understand how to guide patients through acute injury episodes of care and post-injury follow up.

Original languageEnglish (US)
JournalPrehospital Emergency Care
DOIs
StatePublished - Jan 1 2019

Fingerprint

Emergency Medical Services
Physicians
Therapeutics
Wounds and Injuries
Registries
Mortality
Inpatients
Emergencies
Advance Care Planning
Episode of Care
Vital Statistics
Injury Severity Score
Ambulances
Terminal Care
Information Storage and Retrieval
Medicare
Medical Records
Outpatients

Keywords

  • advance care planning
  • emergency medical services (EMS)
  • injury
  • older adults
  • POLST

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

@article{ac5fe4991293437e9216f0dc6b355da7,
title = "Injured Older Adults Transported by Emergency Medical Services: One Year Outcomes by POLST Status",
abstract = "Background: Advance care planning documents, including Physician Orders for Life-Sustaining Treatment (POLST), are intended to guide care near end of life, particularly in emergency situations. Yet, research on POLST during emergency care is sparse. Methods: A total of 7,055 injured patients age ≥ 65 years were transported by 8 emergency medical services (EMS) agencies to 23 hospitals in Oregon. We linked multiple data sources to EMS records, including: the Oregon POLST Registry, Medicare claims data, Oregon Trauma Registry, Oregon statewide inpatient data, and Oregon vital statistics records. We describe patient and event characteristics by POLST status at time of 9-1-1 contact, subsequent changes in POLST forms, and mortality to 12 months. Results: Of 7,055 injured older adults, 1,412 (20.0{\%}) had a registered POLST form at the time of 911 contact. Among the 1,412 POLST forms, 390 (27.6{\%}) specified full orders, 585 (41.4{\%}) limited interventions, and 437 (30.9{\%}) comfort measures only. By one year, 2,471 (35{\%}) patients had completed POLST forms. Among the 4 groups (no POLST, POLST-full orders, POLST-limited intervention, POLST-comfort measures), Injury Severity Scores were similar. Mortality differences were present by 30 days (5.0{\%}, 4.6{\%}, 8.0{\%}, and 13.3{\%}, p < 0.01) and were greater by one year (19.5{\%}, 23.9{\%}, 35.4{\%}, and 46.2{\%}, p < 0.01). Conclusions: Among injured older adults transported by ambulance in Oregon, one in 5 had an active POLST form at the time of 9-1-1 contact, the prevalence of which increased over the following year. Mortality differences by POLST status were evident at 30 days and large by one year. This information could help emergency, trauma, surgical, inpatient, and outpatient clinicians understand how to guide patients through acute injury episodes of care and post-injury follow up.",
keywords = "advance care planning, emergency medical services (EMS), injury, older adults, POLST",
author = "Dana Zive and Craig Newgard and Amber Lin and Aaron Caughey and Susan Malveau and Elizabeth Eckstrom",
year = "2019",
month = "1",
day = "1",
doi = "10.1080/10903127.2019.1615154",
language = "English (US)",
journal = "Prehospital Emergency Care",
issn = "1090-3127",
publisher = "Informa Healthcare",

}

TY - JOUR

T1 - Injured Older Adults Transported by Emergency Medical Services

T2 - One Year Outcomes by POLST Status

AU - Zive, Dana

AU - Newgard, Craig

AU - Lin, Amber

AU - Caughey, Aaron

AU - Malveau, Susan

AU - Eckstrom, Elizabeth

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Advance care planning documents, including Physician Orders for Life-Sustaining Treatment (POLST), are intended to guide care near end of life, particularly in emergency situations. Yet, research on POLST during emergency care is sparse. Methods: A total of 7,055 injured patients age ≥ 65 years were transported by 8 emergency medical services (EMS) agencies to 23 hospitals in Oregon. We linked multiple data sources to EMS records, including: the Oregon POLST Registry, Medicare claims data, Oregon Trauma Registry, Oregon statewide inpatient data, and Oregon vital statistics records. We describe patient and event characteristics by POLST status at time of 9-1-1 contact, subsequent changes in POLST forms, and mortality to 12 months. Results: Of 7,055 injured older adults, 1,412 (20.0%) had a registered POLST form at the time of 911 contact. Among the 1,412 POLST forms, 390 (27.6%) specified full orders, 585 (41.4%) limited interventions, and 437 (30.9%) comfort measures only. By one year, 2,471 (35%) patients had completed POLST forms. Among the 4 groups (no POLST, POLST-full orders, POLST-limited intervention, POLST-comfort measures), Injury Severity Scores were similar. Mortality differences were present by 30 days (5.0%, 4.6%, 8.0%, and 13.3%, p < 0.01) and were greater by one year (19.5%, 23.9%, 35.4%, and 46.2%, p < 0.01). Conclusions: Among injured older adults transported by ambulance in Oregon, one in 5 had an active POLST form at the time of 9-1-1 contact, the prevalence of which increased over the following year. Mortality differences by POLST status were evident at 30 days and large by one year. This information could help emergency, trauma, surgical, inpatient, and outpatient clinicians understand how to guide patients through acute injury episodes of care and post-injury follow up.

AB - Background: Advance care planning documents, including Physician Orders for Life-Sustaining Treatment (POLST), are intended to guide care near end of life, particularly in emergency situations. Yet, research on POLST during emergency care is sparse. Methods: A total of 7,055 injured patients age ≥ 65 years were transported by 8 emergency medical services (EMS) agencies to 23 hospitals in Oregon. We linked multiple data sources to EMS records, including: the Oregon POLST Registry, Medicare claims data, Oregon Trauma Registry, Oregon statewide inpatient data, and Oregon vital statistics records. We describe patient and event characteristics by POLST status at time of 9-1-1 contact, subsequent changes in POLST forms, and mortality to 12 months. Results: Of 7,055 injured older adults, 1,412 (20.0%) had a registered POLST form at the time of 911 contact. Among the 1,412 POLST forms, 390 (27.6%) specified full orders, 585 (41.4%) limited interventions, and 437 (30.9%) comfort measures only. By one year, 2,471 (35%) patients had completed POLST forms. Among the 4 groups (no POLST, POLST-full orders, POLST-limited intervention, POLST-comfort measures), Injury Severity Scores were similar. Mortality differences were present by 30 days (5.0%, 4.6%, 8.0%, and 13.3%, p < 0.01) and were greater by one year (19.5%, 23.9%, 35.4%, and 46.2%, p < 0.01). Conclusions: Among injured older adults transported by ambulance in Oregon, one in 5 had an active POLST form at the time of 9-1-1 contact, the prevalence of which increased over the following year. Mortality differences by POLST status were evident at 30 days and large by one year. This information could help emergency, trauma, surgical, inpatient, and outpatient clinicians understand how to guide patients through acute injury episodes of care and post-injury follow up.

KW - advance care planning

KW - emergency medical services (EMS)

KW - injury

KW - older adults

KW - POLST

UR - http://www.scopus.com/inward/record.url?scp=85066830852&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066830852&partnerID=8YFLogxK

U2 - 10.1080/10903127.2019.1615154

DO - 10.1080/10903127.2019.1615154

M3 - Article

JO - Prehospital Emergency Care

JF - Prehospital Emergency Care

SN - 1090-3127

ER -