The Quality of POLST Decisions in the Nursing Facility Setting

护理机构中 POLST 决策的质量

• 批准号: 9488047
• 负责人: SUSAN E HICKMAN
• 金额: $ 53.95万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-08 至 2020-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9488047
• 关键词: Address; Adopted; Adoption; Advance Care Planning; Advance Directives; Affect; Age; Antibiotics; Articulation; Caring; Characteristics; Code; Cognitive; Conflict (Psychology); Country; Data; Decision Making; Development; Discipline of Nursing; Disease; Documentation; Education; Educational Intervention; Elderly; Ensure; Foundations; Geriatric Nursing; Goals; Intervention; Interview; Knowledge; Legal; Life; Living Wills; Medical; Medical Errors; Methods; Minority; Outcome; Palliative Care; Patients; Perception; Physicians; Policies; Policy Maker; Research; Resuscitation; Science; Standardization; Statutes and Laws; Time; Training; Treatment outcome; United States; Work; base; clinical practice; health literacy; hospice environment; nutrition; older patient; patient oriented; preference; public health relevance; satisfaction; support tools; therapy development; treatment program

 DESCRIPTION (provided by applicant): The Physician Orders for Life-Sustaining Treatment (POLST) was developed to overcome the limitations of traditional approaches to honoring the treatment preferences of seriously ill geriatric patients by documenting treatment preferences in the form of medical orders. These standing orders are based on a conversation between a POLST facilitator (often a non-physician) and the decision-maker (patient or the legal surrogate of patients who lack decisional capacity). Once signed by the decision-maker and treating physician, POLST remains in effect until revised or revoked. Research suggests that POLST facilitates the documentation of a wide range of treatment preferences to have or decline interventions and its use directly affects treatment outcomes. POLST is used to guide the care of elderly patients in over 20 states and has been identified as a preferred palliative care practice. It is widely used in nursing facilities and hospices, where patients have significant palliative care needs. In order to ensure decision quality and avoid medical errors, POLST orders must be concordant with the decision maker's current preferences. Consistent with the goals of PA-13-354, this project is intended to advance the science of geriatric palliative care. Our objective is to evaluate the quality of POLST decisions by determining the level of discordance between POLST orders and decision- makers' preferences and describe modifiable factors associated with discordance. In order to achieve this objective, an observational, mixed-methods study will be conducted with 320 long-stay nursing facility patients or their surrogates to achieve the following specific aims: 1) Determine the level of discordance between current decision-maker (patient or surrogate) treatment preferences and standing POLST orders; 2) Identify correlates of discordance between current treatment preferences and standing POLST orders, controlling for time in days since POLST form completion; 3) Describe perceptions of the reason(s) for discordance between current treatment preferences and standing POLST orders, controlling for time in days since POLST form completion; and 4) Assess the relationship between POLST discordance and decision quality outcomes. It is expected that findings will guide improvements in advance care planning practices by identifying modifiable factors associated with POLST discordance to direct the development of tailored decision support tools and educational interventions. These data are requisite to guide improvements in clinical practice and inform policy makers working on POLST legislation and reimbursement reform at the state and federal levels.

 描述（由适用提供）：开发了维持生命治疗的医师命令（POLST），以克服传统方法的局限性，通过记录医疗命令形式的治疗偏好来尊重严重病重的老年患者的治疗偏好。这些常规订单基于Polst促进者（通常是非医师）与决策者（患者或缺乏决策能力的患者的法定代理）之间的对话。一旦由决策者和治疗医师签署，Polst一直有效，直到修订或撤销为止。研究表明，POLST准备了各种治疗偏好的文献，以进行干预措施，其使用直接影响治疗结果。 Polst用于指导20多个州的老年患者的护理，并被确定为首选的姑息治疗实践。它被广泛用于护理设施和医院，患者满足了姑息治疗的巨大护理需求。为了确保决策质量并避免医疗错误，Polst命令必须与决策者当前的偏好一致。与PA-13-354的目标一致，该项目旨在推进老年姑息治疗的科学。我们的目标是通过确定Polst订单与决策者的偏好之间的不一致水平来评估Polst决策的质量，并描述与不一致相关的可修改因素。为了实现这一目标，将对320名长期护理设施患者或其替代物进行观察性混合方法研究，以实现以下特定目标：1）确定当前决策者（患者或替代）治疗偏好和常规命令之间的不和谐水平； 2）确定当前治疗偏好与站立命令之间不一致的相关性，以自Polst形式完成以来的天数控制； 3）描述对当前治疗偏好和站立订单之间不一致的原因的看法，从而控制了自Polst Form完成以来的天数； 4）评估波斯特不一致与决策质量结果之间的关系。可以预期，调查结果将通过确定与Polst不一致相关的可修改因素来指导定制的决策支持工具和教育干预措施来指导改善护理计划实践。这些数据需要指导临床实践的改进，并为在州和联邦一级从事Polst立法和报销改革的政策制定者提供信息。

项目成果

Reasons for discordance and concordance between POLST orders and current treatment preferences.

• DOI: 10.1111/jgs.17097
• 发表时间: 2021-07
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Hickman SE;Torke AM;Heim Smith N;Myers AL;Sudore RL;Hammes BJ;Sachs GA
• 通讯作者: Sachs GA

Factors associated with concordance between POLST orders and current treatment preferences.

• DOI: 10.1111/jgs.17095
• 发表时间: 2021-07
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Hickman SE;Torke AM;Sachs GA;Sudore RL;Tang Q;Bakoyannis G;Heim Smith N;Myers AL;Hammes BJ
• 通讯作者: Hammes BJ

Use of the Physician Orders for Scope of Treatment Program in Indiana Nursing Homes.

• DOI: 10.1111/jgs.15338
• 发表时间: 2018-07
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Hickman SE;Sudore RL;Sachs GA;Torke AM;Myers AL;Tang Q;Bakoyannis G;Hammes BJ
• 通讯作者: Hammes BJ