Use of Medical Orders for Scope of Treatment for Heart Failure Patients During Postacute Care in Skilled Nursing Facilities.

The analysis was retrospective and used participants from a trial, so it could not show that a MOST form caused goal-concordant care. Forms were not collected from all skilled nursing facilities, and it was unclear whether missing forms were absent or never completed. The completion rate may reflect poor form availability in some facilities rather than true patient-provider completion. The sample was small for the number of facilities and providers, and clustering effects were not adjusted. Follow-up was only 60 days, so longer-term care transitions and mortality were not assessed. Goal-concordant care was assessed only among patients with valid forms who had an emergency visit or hospitalization. Many forms were invalid because dates or signatures were missing, so the documented preferences may not represent all patients.

The authors declare no conflicts of interest.

Do not read the 95% goal-concordant rate as proof that MOST forms always guide care. It applies only to 66 patients with valid forms who had an emergency visit or hospitalization, and forms were not available from all facilities.