Impact of the Physician Orders for Life-Sustaining Treatment (POLST) Program Maturity Status on the Nursing Home Resident's Place of Death.
Aluem Tark, Mansi Agarwal, Andrew W Dick and 2 others
PMID 32878457WHAT IT FOUND
Long-stay nursing home residents in mature POLST states had 20% higher odds of dying in the facility.
Developing states had 12% higher odds. Short-stay residents showed no difference.
Key findings
01Among long-stay residents, mature POLST maturity status was associated with 20% higher odds of nursing home death compared with non-conforming states (OR 1.20, 95% CI 1.02-1.43).
02Among long-stay residents, developing POLST status was associated with 12% higher odds of nursing home death compared with non-conforming states (OR 1.12, 95% CI 1.02-1.24), while endorsed status showed an 11% increase but lacked significance (OR 1.09).
03There was no difference for short-stay residents.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis is cross-sectional, so it shows an association between state POLST maturity and nursing home death, not that POLST caused the outcome. POLST maturity was measured at the state level, and the data did not show whether residents had POLST forms completed or what their preferences were. Place of death was only nursing home versus non-nursing home, so it cannot distinguish death at home, in hospital, or in hospice. Discharge to community or hospice was ambiguous in the data, because community could include assisted living or group homes, and hospice could include a hospice unit inside the facility. Only 1% of states were mature and 5% were non-conforming, while 59% were developing and 35% were endorsed, so comparisons with mature and non-conforming states rest on small state counts. The study used deaths from 2013 and assessments from 2012-2013.
The easy way to misread this
Do not conclude that POLST programs caused residents to die in nursing homes. This was a cross-sectional association using state-level POLST maturity, and the data did not assess whether individual residents had POLST forms completed or preferences.