The Physician Orders for Life-Sustaining Treatment (POLST) program was developed to enhance quality of care delivered at End-of-Life (EoL). Although positive impacts of the POLST program have been identified, the association between a program maturity status and nursing home resident’s likelihood of dying in their current care settings remain unanswered. This study aims to evaluate the impact of the POLST program maturity status on nursing home residents’ place of death. Using multiple national-level datasets, we examined total 595,152 residents and their place of death. The result showed that the long-stay residents living in states where the program was mature status had 12% increased odds of dying in nursing homes compared that of non-conforming status. Individuals residing in states with developing program status showed 11% increase in odds of dying in nursing homes. The findings demonstrate that a well-structured and well-disseminated POLST program, combined with a continued effort to meet high standards of quality EoL care, can bring out positive health outcomes for elderly patients residing in care settings.
Harris-KojetinLSenguptaMPark-LeeE, et al.Long-term care providers and services users in the United States: data from the national study of long-term care providers, 2013–2014. In: National Center for Health Statistics, ed. Vital Health Stat. 2016;3(38):1–105.
2.
BarberaLSeowHSutradharR, et al.quality indicators of end-of-life care in patients with cancer: what rate is right?J Oncol Pract. 2015;11(3):e279–287.
3.
HouserA.Long-Term Care. AARP Public Policy Institute; 2007.
4.
De RooMLMiccinesiGOnwuteaka-PhilipsenBD, et al.Actual and preferred place of death of home-dwelling patients in four European countries: making sense of quality indicators. PLoS One. 2014;9(4):e93762–e93762.
5.
MiyashitaMMoritaTIchikawaTSatoKShimaYUchitomiY. Quality indicators of end-of-life cancer care from the bereaved family members’ perspective in Japan. J Pain Symptom Manage. 2009;37(6):1019–1026.
6.
Institute of Medicine (US) and National Research Council (US) National Cancer Policy Board. Quality of Care and Quality Indicators for End-of-Life Cancer Care: Hope for the Best, Yet Prepare for the Worst. Vol 3. National Academies Press (US); 2001.
7.
DonaldsonMSFieldMJ. Measuring quality of care at the end of life. Arch Intern Med. 1998;158(2):121–128.
8.
WengerNSRosenfeldK. Quality indicators for end-of-life care in vulnerable elders. Ann Intern Med. 2001;135(8_Part_2):677–685.
9.
SilvesterWParslowRALewisVJ, et al.Development and evaluation of an aged care specific advance care plan. BMJ Support Palliat Care. 2013;3(2):188–195.
10.
EarleCCParkERLaiBWeeksJCAyanianJZBlockS. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol. 2003;21(6):1133–1138.
11.
Temkin-GreenerHZhengNTXingJMukamelDB. Site of death among nursing home residents in the United States: changing patterns, 2003-2007. J Am Med Dir Assoc. 2013;14(10):741–748.
12.
LeporeMLelandNE. Nursing homes that increased the proportion of Medicare days saw gains in quality outcomes for long-stay residents. Health Aff (Project Hope). 2015;34(12):2121–2128.
13.
ZieglerLECraigsCLWestRM, et al.Is palliative care support associated with better quality end-of-life care indicators for patients with advanced cancer? A retrospective cohort study. BMJ Open. 2018;8(1): e018284.
14.
WattmoCWallinÅK. Early- versus late-onset Alzheimer disease: long-term functional outcomes, nursing home placement, and risk factors for rate of progression. Dement Geriatr Cogn Dis Extra. 2017;7(1):172–187.
15.
SafarpourD. Nursing home and end-of-life care in Parkinson disease. Neurology. 2015;85(5):413–419.
16.
HebertLEScherrPABieniasJLBennettDAEvansDA. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol. 2003;60(8):1119–1122.
17.
LueckelSN. Population of patients with traumatic brain injury in skilled nursing facilities: a decade of change. J Head Trauma Rehabil. 2019;34(1):E39–E45.
18.
Jerez-RoigJ. Prevalence of urinary incontinence and associated factors in nursing home residents urinary incontinence in nursing home residents. Neurourol Urodyn. 2016;35(1):102–107.
19.
GabbeBLowthianJDwyerRStoelwinderJU. A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities. Age Ageing. 2014;43(6):766.
20.
LaurentMBoriesPNLe ThuautA, et al.Impact of comorbidities on hospital-acquired infections in a geriatric rehabilitation unit: prospective study of 252 patients. J Am Med Dir Assoc. 2012;13(8):760.e767–760.e712.
21.
GruneirAMorVWeitzenSTruchilRTenoJRoyJ. Where people die: a multilevel approach to understanding influences on site of death in America. Med Care Res Rev: MCRR. 2007;64(4):351–378.
22.
LambergJLPersonCJKielyDKMitchellSL. Decisions to hospitalize nursing home residents dying with advanced dementia. J Am Geriatr Soc. 2005;53(8):1396–1401.
23.
MorleyJE. Opening pandora’s box: the reasons why reducing nursing home transfers to hospital are so difficult. J Am Med Dir Assoc. 2016;17(3):185–187.
24.
Van der SteenJTLemos DekkerNGijsbertsM-JHEVermeulenLHMahlerMMTheBA-M. Palliative care for people with dementia in the terminal phase: a mixed-methods qualitative study to inform service development. BMC Palliat Care. 2017;16(1):28.
25.
Temkin-GreenerHZhengNTNortonSAQuillTLadwigSVeazieP. Measuring end-of-life care processes in nursing homes. The Gerontologist. 2009;49(6):803–815.
26.
SalibaDKingtonRBuchananJ, et al.Appropriateness of the decision to transfer nursing facility residents to the hospital. J Am Geriatr Soc. 2000;48(2):154–163.
27.
TenoJMGozaloPLBynumJPW, et al.Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470–477.
FrommeEKZiveDSchmidtTACookJNTolleSW. Association between physician orders for life-sustaining treatment for scope of treatment and in-hospital death in Oregon. J Am Geriatr Soc. 2014;62(7):1246–1251.
31.
TuckKKZiveDMSchmidtTACarterJNuttJFrommeEK. Life-sustaining treatment orders, location of death and co-morbid conditions in decedents with Parkinson’s disease. Parkinsonism Relat Disord. 2015;21(10):1205–1209.
32.
HickmanSE. Use of the physician orders for scope of treatment program in Indiana nursing homes use of Indiana post in nursing homes. J Am Geriatr Soc (JAGS). 2018;66(6):1096–1100.
33.
KimHErsekMBradwayCHickmanSE. Physician orders for life-sustaining treatment for nursing home residents with dementia. J Am Assoc Nurse Pract. 2015;27(11):606–614.
KnestrickMWPedrazaSLCulpSFalkenstineECMossAH. Benefits of physician orders for scope of treatment (POST) forms on end-of-life care in cancer patients: insights from the West Virginia Registry. J Clin Oncol. 2016;34(15_suppl):10006–10006.
36.
NugentSMSlatoreCGGanziniL, et al.POLST registration and associated outcomes among veterans with advanced-stage lung cancer. Am J Hosp Palliat Care. 2019;36(7):564–570. doi: 1049909118824543
37.
LumHD. Advance care planning in the elderly. Med Clin North Am. 2015;99(2):391–403.
38.
SebastianP. Healthcare professionals’ perceptions and use of the provider orders for life-sustaining treatment (POLST) form. J Am Med Dir Assoc. 2017;18(3): B22–B23.
39.
BraunUK. Experiences with POLST: opportunities for improving advance care planning. J Gen Intern Med. 2016;31(10):1111–1112.
40.
TarkAAgarwalMDickAWStonePW. Variations in physician orders for life-sustaining treatment program across the nation: environmental scan. J Palliat Med. 2019;22(9):1032–1038.
41.
MorleyJE. Minimum data set 3.0: a giant step forward. J Am Med Dir Assoc. 2013;14(1):1–3.
42.
SalibaDBuchananJ. Making the investment count: revision of the minimum data set for nursing homes, MDS 3.0. J Am Med Dir Assoc. 2012;13(7):602–610.
43.
WysockiAThomasKS, Mor V. functional improvement among short-stay nursing home residents in the MDS 3.0. J Am Med Dir Assoc. 2015;16(6):470–474.
44.
LucasJABowblisJR. CMS strategies to reduce antipsychotic drug use in nursing home patients with dementia show some progress. Health Aff (Millwood). 2017;36(7):1299–1308.
45.
HunnicuttJNTjiaJLapaneKL. Hospice use and pain management in elderly nursing home residents with cancer. J Pain Symptom Manage. 2017;53(3):561–570.
46.
DickAWBellJMStoneNDChastainAMSorberoMStonePW. Nursing home adoption of the national healthcare safety network long-term care facility component. Am J Infect Control. 2019;47(1):59–64.
47.
HolupAAGassoumisZDWilberKHHyerK. Community discharge of nursing home residents: the role of facility characteristics. Health Serv Res. 2016;51(2):645–666.
MillerSCLimaJCIntratorOMartinEBullJHansonLC. Palliative care consultations in nursing homes and reductions in acute care use and potentially burdensome end-of-life transitions. J Am Geriatr Soc. 2016;64(11):2280–2287.
50.
PhillipsLJBirtleyNMPetroskiGFSiemCRantzM. An observational study of antipsychotic medication use among long-stay nursing home residents without qualifying diagnoses. J Psychiatr Ment Health Nurs. 2018;25(8):463–474.
51.
JenniferTMarisaDJaneLG. Advance directives among nursing home residents with mild, moderate, and advanced dementia. J Palliat Med. 2018;21(1):16–21.
52.
Temkin-GreenerHLeeTCaprioTCaiS. Rehabilitation therapy for nursing home residents at the end-of-life. J Am Med Dir Assoc. 2019;20(4):476–480.e1. doi:10.1016/j.jamda.2018.07.024.
53.
CarpenterGIHastieCLMorrisJNFriesBEAnkriJ. Measuring change in activities of daily living in nursing home residents with moderate to severe cognitive impairment. BMC Geriatr. 2006;6(1):7.
54.
GrabowskiDCFengZHirthRRahmanMMorV. Effect of nursing home ownership on the quality of post-acute care: an instrumental variables approach. J Health Econ. 2013;32(1):12–21.
55.
CohenCCEngbergJHerzigCTADickAWStonePW. Nursing homes in states with infection control training or infection reporting have reduced infection control deficiency citations. Infect Control Hosp Epidemiol. 2015;36(12):1475–1476.
56.
Benjamin-ChungJAbedinJBergerD, et al.Spillover effects on health outcomes in low- and middle-income countries: a systematic review. Int J Epidemiol. 2017;46(4):1251–1276.
57.
NandaAMartinEWWelchLCMillerSC. Referral and timing of referral to hospice care in nursing homes: the significant role of staff members. Gerontologist. 2008;48(4):477–484.
58.
PearsonMLWyte-LakeTBowmanCNeedlemanJDobalianA. Assessing the impact of academic-practice partnerships on nursing staff. BMC Nursing. 2015;14(1):28.
59.
SprangersSDijkstraKRomijn-LuijtenA. Communication skills training in a nursing home: effects of a brief intervention on residents and nursing aides. Clin Interv Aging. 2015;10:311–319. Published January 20, 2015:311–319. doi:10.2147/CIA.S73053.
60.
MillerSCMorVWuNGozaloPLapaneK. Does receipt of hospice care in nursing homes improve the management of pain at the end of life?J Am Geriatr Soc. 2002;50(3):507–515.
61.
ZhengNTMukamelDBFriedmanBCaprioTVTemkin-GreenerH. The effect of hospice on hospitalizations of nursing home residents. J Am Med Dir Assoc. 2015;16(2):155–159.
62.
MillerSCGozaloPMorV. Hospice enrollment and hospitalization of dying nursing home patients. Am J Med. 2001;111(1):38–44.
63.
MillerSCMorVNT. The role of hospice care in the nursing home setting. J Palliat Med. 2002;5(2):271–277.
64.
MillerSCLimaJCThompsonSA. End-of-life care in nursing homes with greater versus less palliative care knowledge and practice. J Palliat Med. 2015;18(6):527–534.
65.
LebenthalJBarileDSedhomR. Does use of the POLST form implicate overall care for patients with advanced cancer syndromes?J Clin Oncol. 2017;35(31_suppl):15–15.
66.
BallouJHDeweyEZoniesDH. Elderly patients presenting to a level I trauma center with a POLST form: a propensity-matched analysis. J Trauma Acute Care Surg. 2019;87(1):153–160. doi:10.1097/TA.0000000000002321.
67.
LeeMABrummel-SmithKMeyerJDrewNLondonMR. Physician orders for life-sustaining treatment (POLST): outcomes in a PACE program. Program of all-inclusive care for the elderly. J Am Geriatr Soc. 2000;48(10):1219–1225.
68.
Guidelines for emergency physicians on the interpretation of physician orders for life-sustaining therapy (POLST). Ann Emerg Med. 2017;70(1):122–125.
69.
LammersAJZiveDMTolleSWFrommeEK. The oncology specialist’s role in POLST form completion. Am J Hosp Palliat Care. 2018;35(2):297–303.
70.
SchmidtTAHickmanSETolleSWBrooksHS. The physician orders for life-sustaining treatment program: oregon emergency medical technicians’ practical experiences and attitudes. J Am Geriatr Soc. 2004;52(9):1430–1434.
71.
PerrelsAJFlemingJZhaoJ, et al.Place of death and end-of-life transitions experienced by very old people with differing cognitive status: retrospective analysis of a prospective population-based cohort aged 85 and over. Palliat Med. 2013;28(3):220–233.
72.
PorockDOliverDPZweigS, et al.Predicting death in the nursing home: development and validation of the 6-month minimum data set mortality risk index. J Gerontol A Biol Sci Med Sci.. 2005;60(4):491–498.
73.
DragesetJEideGERanhoffAH. Mortality in nursing home residents without cognitive impairment and its relation to self-reported health-related quality of life, sociodemographic factors, illness variables and cancer diagnosis: a 5-year follow-up study. Qual Life Res. 2013;22(2):317–325.
74.
Van RensbergenGNawrotTSVan HeckeENemeryB. Where do the elderly die? The impact of nursing home utilisation on the place of death. Observations from a mortality cohort study in Flanders. BMC Public Health. 2006;6(1):178.
75.
VossiusCSelbækGŠaltytė BenthJBerghS. Mortality in nursing home residents: a longitudinal study over three years. PLOS One. 2018;13(9): e0203480.
76.
ZhangXDouQZhangW, et al.Frailty as a predictor of all-cause mortality among older nursing home residents: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019;20(6):657–663.e4.
77.
HjaltadottirIHallbergIREkwallAKNybergP. Predicting mortality of residents at admission to nursing home: a longitudinal cohort study. BMC Health Serv Res.2011;11:86. Published April 20, 2011. doi:10.1186/1472-6963-11-86.
78.
SalomonSChuangEBhupaliDLabovitzD. Race/ethnicity as a predictor for location of death in patients with acute neurovascular events. Am J Hosp Palliat Care. 2018;35(1):100–103.
79.
KwakJHaleyWEChiribogaDA. Racial differences in hospice use and in-hospital death among Medicare and Medicaid dual-eligible nursing home residents. Gerontologist. 2008;48(1):32–41.
80.
Sund-LevanderMGrodzinskyEWahrenLK. Gender differences in predictors of survival in elderly nursing-home residents: a 3-year follow up. Scand J Caring Sci. 2007;21(1):18–24.
81.
LapaneKLGambassiGLandiFSgadariAMorVBernabeiR. Gender differences in predictors of mortality in nursing home residents with AD. Neurology. 2001;56(5):650.
82.
FernandezHHLapaneKL. Predictors of mortality among nursing home residents with a diagnosis of Parkinson’s disease. Med Sci Monit. 2002;8(4): Cr241–246.
83.
HoffmannFAllersK. Age and sex differences in hospitalisation of nursing home residents: a systematic review. BMJ Open. 2016;6(10): e011912.
84.
LeeJSChauPPHuiEChanFWooJ. Survival prediction in nursing home residents using the minimum data set subscales: ADL self-performance hierarchy, cognitive performance and the changes in health, end-stage disease and symptoms and signs scales. Eur J Public Health. 2009;19(3):308–312.
