Robert Y.\u00a0Lee,\u00a0Lyndia C.\u00a0Brumback,\u00a0Seelwan\u00a0Sathitratanacheewin,\u00a0et al<\/h3>\n\n\n\nJAMA.\u00a0<\/em>Published online February 16, 2020. doi:10.1001\/jama.2019.22523<\/h3>\n\n\n\nAbstract<\/h2>\n\n\n\nImportance<\/strong><\/h3>\n\n\n\nPatients with chronic illness frequently use Physician Orders for Life-Sustaining Treatment (POLST) to document treatment limitations.<\/p>\n\n\n\n
Objectives<\/strong><\/h3>\n\n\n\nTo evaluate the association between POLST order for medical interventions and intensive care unit (ICU) admission for patients hospitalized near the end of life.<\/p>\n\n\n\n
Design, Setting, and Participants<\/strong><\/h3>\n\n\n\nRetrospective cohort study of patients with POLSTs and with chronic illness who died between January 1, 2010, and December 31, 2017, and were hospitalized 6 months or less before death in a 2-hospital academic health care system.<\/p>\n\n\n\n
Exposures<\/strong><\/h3>\n\n\n\nPOLST order for medical interventions (\u201ccomfort measures only\u201d vs \u201climited additional interventions\u201d vs \u201cfull treatment\u201d), age, race\/ethnicity, education, days from POLST completion to admission, histories of cancer or dementia, and admission for traumatic injury.<\/p>\n\n\n\n
Main Outcomes and Measures<\/strong><\/h3>\n\n\n\nThe primary outcome was the association between POLST order and ICU admission during the last hospitalization of life; the secondary outcome was receipt of a composite of 4 life-sustaining treatments: mechanical ventilation, vasopressors, dialysis, and cardiopulmonary resuscitation. For evaluating factors associated with POLST-discordant care, the outcome was ICU admission contrary to POLST order for medical interventions during the last hospitalization of life.<\/p>\n\n\n\n
Results<\/strong><\/h3>\n\n\n\nAmong 1818 decedents (mean age, 70.8 [SD, 14.7] years; 41% women), 401 (22%) had POLST orders for comfort measures only, 761 (42%) had orders for limited additional interventions, and 656 (36%) had orders for full treatment. ICU admissions occurred in 31% (95% CI, 26%-35%) of patients with comfort-only orders, 46% (95% CI, 42%-49%) with limited-interventions orders, and 62% (95% CI, 58%-66%) with full-treatment orders. One or more life-sustaining treatments were delivered to 14% (95% CI, 11%-17%) of patients with comfort-only orders and to 20% (95% CI, 17%-23%) of patients with limited-interventions orders. Compared with patients with full-treatment POLSTs, those with comfort-only and limited-interventions orders were significantly less likely to receive ICU admission (comfort only: 123\/401 [31%] vs 406\/656 [62%], aRR, 0.53 [95% CI, 0.45-0.62]; limited interventions: 349\/761 [46%] vs 406\/656 [62%], aRR, 0.79 [95% CI, 0.71-0.87]). Across patients with comfort-only and limited-interventions POLSTs, 38% (95% CI, 35%-40%) received POLST-discordant care. Patients with cancer were significantly less likely to receive POLST-discordant care than those without cancer (comfort only: 41\/181 [23%] vs 80\/220 [36%], aRR, 0.60 [95% CI, 0.43-0.85]; limited interventions: 100\/321 [31%] vs 215\/440 [49%], aRR, 0.63 [95% CI, 0.51-0.78]). Patients with dementia and comfort-only orders were significantly less likely to receive POLST-discordant care than those without dementia (23\/111 [21%] vs 98\/290 [34%], aRR, 0.44 [95% CI, 0.29-0.67]). Patients admitted for traumatic injury were significantly more likely to receive POLST-discordant care (comfort only: 29\/64 [45%] vs 92\/337 [27%], aRR, 1.52 [95% CI, 1.08-2.14]; limited interventions: 51\/91 [56%] vs 264\/670 [39%], aRR, 1.36 [95% CI, 1.09-1.68]). In patients with limited-interventions orders, older age was significantly associated with less POLST-discordant care (aRR, 0.93 per 10 years [95% CI, 0.88-1.00]).<\/p>\n\n\n\n![\"\"\/](\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/0\/m_joi190156f1.png?Expires=2147483647&Signature=l9kcmApptDBVpcetCnQfKSp9GkFI6E91f00htVC2C4Bn5dK1mBHMx5wZUcTK88PaScxq3KOimyT8Is6sC1KqRYYJwgoT98CImANrrw5GLiPhGC8TXxdcb50h2w7qkLixi3LbngjQHLvVg~pcRlATjqPSaPWyfXrVSd3mqLT0X0di0A6xvcu4eOgwjUVrMZGRHxGuHfl5C4ts1SWDu9p0FKF1k2EM7gGxNoL5FY6b8Hlg48eUO0edJXThHEIJkpSXwR-FIYXgUXyPwRgvknbl2eK6KuM4NypGugDoaTql4ifESx6SX69mu2fD0CPNVSexfLqnC-7txLxz-0zd2XelXA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\")
<\/figure>\n\n\n\n![\"\"\/](\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/0\/m_joi190156f2.png?Expires=2147483647&Signature=ca1mQ4yM~b1D57xbcx29MQP~B7L3kLCwZdq9t3CQiFUfKOq~dtpWLZl5mSr7LDKfkHWfvxoBRnQSN~6ox4rieNbBL8mpjk7sQCWCKw61CNFyUNLRjxzRpwuXsosdWEYVLQuBXwTwJQMxkN0CO3J6X8VCOoDk2xoXbIWPLt6aXH8bg1XCEvrQhA9mVBPmuNi552rgE1dfPdULb9ZjcxCGM0kLZqV4ULWXO0jFyfa~u6NMXcap2Ru-R0cdAkord41CpqpFAOeHDttuKyPrSyeuKhuKiyjCTjFBmBeqpLhxEt9mhrom~8atClKADSmvdYef9OBYUyWOcoZgs7Z-sAWluQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\")
<\/figure>\n\n\n\n![\"\"\/](\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/0\/m_joi190156f3.png?Expires=2147483647&Signature=TQX9ipuXR7rLFiNnIyl5buW-xcgoKVUm68gHLjXXsPP2DBm~1TpFCIaMVdkLkd~xeiV54XgZdeOmqgt3wV6KLGiSbXhzZEa~dEoqHV8-OtjHDrSCNDklfNu4HwiiYSyvAxFlq5bNp1N0~ouufEcSSdIG3lRAA6baViDFNcA6YznvOIV7D-sgnV7-ZeApuE-j9WJihljtWNVvQh9QCrB3SIp0BpRh4YRqTpdFGL72q3iTgIML0mcBbSZ3frJfNeweVe8buGrleLY6noYwM3DtO5Unsyg2wHqeeYO2uDpflFQhPjQbdCWXUa3iQpk2L58gFhEMpl4ufixCu8sWigkYRg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\")
<\/figure>\n\n\n\n![\"\"\/](\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/0\/m_joi190156t1.png?Expires=2147483647&Signature=JJMO2UV0rn7jDK9nnmOONQ5sFowPatRibgrBlIFWOQXWfagAsD6kZEoIuKkfqrH4V8O~D3NkZRE~7jEQhc1G5ZjoJ7hE8JDUB7DfQBuQ~S-66Iw0HCV9BhMRMVJwjKEyC~c-qKwiLYizDj5SF7cRtwd3Z-5cCDPUxCnIAUa3DCotn9uXAW6yf3zHaNpIwRT5wBZ4J5yeufruS82RD33s~qgjOLy16ncgMkz1AU50PE69VGJtMxYv4pV6hmXujGv5DYDMDCzp0dotIukIrAnUsKAyY-TMlFipTC5L7C4f0F-Y55mCJLLOiukeWd~6ipn3sgFQB9AydW~BIOoDUny-lw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\")
<\/figure>\n\n\n\n![\"\"\/](\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/0\/m_joi190156t2.png?Expires=2147483647&Signature=ga6m70q5TGViQ8tDzjI1xrAhDm7HCFYUvhqXalcWzjh3fKjKJnO65rIQoTvVPCgTCXFXTpTaA08PIyv58nIyNAhxlNf5-Lm8xnhXRe2dwlc2c6lVM0PRET85WinD8G6jWqLQvoGSSlcv77nHDg-QOnO3N6CwW-zy0QIvmuT2RzWPTOFUXVdyTjZHa0ncPQach3fsmau26i2qIGJdUpgG7~8-uKb4ZR3O4OjmJH1K3N9LNz~cba7soAksZoTOiKUxQdYrL-yc5awOvCcFB2-HCjRT1CeD43Q7QtomHbfwvVOac2mrZU0wvolDsy-rgHBJ6-ycz8eLBt3uJTnMeg607w__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\")
<\/figure>\n\n\n\nConclusions and Relevance<\/strong><\/h3>\n\n\n\nAmong patients with POLSTs and with chronic life-limiting illness who were hospitalized within 6 months of death, treatment-limiting POLSTs were significantly associated with lower rates of ICU admission compared with full-treatment POLSTs. However, 38% of patients with treatment-limiting POLSTs received intensive care that was potentially discordant with their POLST.<\/p>\n","protected":false},"excerpt":{"rendered":"
Original Investigation Caring for the Critically I […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18691"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691\/revisions"}],"predecessor-version":[{"id":18693,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691\/revisions\/18693"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18691"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18691"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18691"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Abstract<\/h2>\n\n\n\nImportance<\/strong><\/h3>\n\n\n\nPatients with chronic illness frequently use Physician Orders for Life-Sustaining Treatment (POLST) to document treatment limitations.<\/p>\n\n\n\n
Objectives<\/strong><\/h3>\n\n\n\nTo evaluate the association between POLST order for medical interventions and intensive care unit (ICU) admission for patients hospitalized near the end of life.<\/p>\n\n\n\n
Design, Setting, and Participants<\/strong><\/h3>\n\n\n\nRetrospective cohort study of patients with POLSTs and with chronic illness who died between January 1, 2010, and December 31, 2017, and were hospitalized 6 months or less before death in a 2-hospital academic health care system.<\/p>\n\n\n\n
Exposures<\/strong><\/h3>\n\n\n\nPOLST order for medical interventions (\u201ccomfort measures only\u201d vs \u201climited additional interventions\u201d vs \u201cfull treatment\u201d), age, race\/ethnicity, education, days from POLST completion to admission, histories of cancer or dementia, and admission for traumatic injury.<\/p>\n\n\n\n
Main Outcomes and Measures<\/strong><\/h3>\n\n\n\nThe primary outcome was the association between POLST order and ICU admission during the last hospitalization of life; the secondary outcome was receipt of a composite of 4 life-sustaining treatments: mechanical ventilation, vasopressors, dialysis, and cardiopulmonary resuscitation. For evaluating factors associated with POLST-discordant care, the outcome was ICU admission contrary to POLST order for medical interventions during the last hospitalization of life.<\/p>\n\n\n\n
Results<\/strong><\/h3>\n\n\n\nAmong 1818 decedents (mean age, 70.8 [SD, 14.7] years; 41% women), 401 (22%) had POLST orders for comfort measures only, 761 (42%) had orders for limited additional interventions, and 656 (36%) had orders for full treatment. ICU admissions occurred in 31% (95% CI, 26%-35%) of patients with comfort-only orders, 46% (95% CI, 42%-49%) with limited-interventions orders, and 62% (95% CI, 58%-66%) with full-treatment orders. One or more life-sustaining treatments were delivered to 14% (95% CI, 11%-17%) of patients with comfort-only orders and to 20% (95% CI, 17%-23%) of patients with limited-interventions orders. Compared with patients with full-treatment POLSTs, those with comfort-only and limited-interventions orders were significantly less likely to receive ICU admission (comfort only: 123\/401 [31%] vs 406\/656 [62%], aRR, 0.53 [95% CI, 0.45-0.62]; limited interventions: 349\/761 [46%] vs 406\/656 [62%], aRR, 0.79 [95% CI, 0.71-0.87]). Across patients with comfort-only and limited-interventions POLSTs, 38% (95% CI, 35%-40%) received POLST-discordant care. Patients with cancer were significantly less likely to receive POLST-discordant care than those without cancer (comfort only: 41\/181 [23%] vs 80\/220 [36%], aRR, 0.60 [95% CI, 0.43-0.85]; limited interventions: 100\/321 [31%] vs 215\/440 [49%], aRR, 0.63 [95% CI, 0.51-0.78]). Patients with dementia and comfort-only orders were significantly less likely to receive POLST-discordant care than those without dementia (23\/111 [21%] vs 98\/290 [34%], aRR, 0.44 [95% CI, 0.29-0.67]). Patients admitted for traumatic injury were significantly more likely to receive POLST-discordant care (comfort only: 29\/64 [45%] vs 92\/337 [27%], aRR, 1.52 [95% CI, 1.08-2.14]; limited interventions: 51\/91 [56%] vs 264\/670 [39%], aRR, 1.36 [95% CI, 1.09-1.68]). In patients with limited-interventions orders, older age was significantly associated with less POLST-discordant care (aRR, 0.93 per 10 years [95% CI, 0.88-1.00]).<\/p>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nConclusions and Relevance<\/strong><\/h3>\n\n\n\nAmong patients with POLSTs and with chronic life-limiting illness who were hospitalized within 6 months of death, treatment-limiting POLSTs were significantly associated with lower rates of ICU admission compared with full-treatment POLSTs. However, 38% of patients with treatment-limiting POLSTs received intensive care that was potentially discordant with their POLST.<\/p>\n","protected":false},"excerpt":{"rendered":"
Original Investigation Caring for the Critically I […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18691"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691\/revisions"}],"predecessor-version":[{"id":18693,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691\/revisions\/18693"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18691"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18691"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18691"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Patients with chronic illness frequently use Physician Orders for Life-Sustaining Treatment (POLST) to document treatment limitations.<\/p>\n\n\n\n
Objectives<\/strong><\/h3>\n\n\n\nTo evaluate the association between POLST order for medical interventions and intensive care unit (ICU) admission for patients hospitalized near the end of life.<\/p>\n\n\n\n
Design, Setting, and Participants<\/strong><\/h3>\n\n\n\nRetrospective cohort study of patients with POLSTs and with chronic illness who died between January 1, 2010, and December 31, 2017, and were hospitalized 6 months or less before death in a 2-hospital academic health care system.<\/p>\n\n\n\n
Exposures<\/strong><\/h3>\n\n\n\nPOLST order for medical interventions (\u201ccomfort measures only\u201d vs \u201climited additional interventions\u201d vs \u201cfull treatment\u201d), age, race\/ethnicity, education, days from POLST completion to admission, histories of cancer or dementia, and admission for traumatic injury.<\/p>\n\n\n\n
Main Outcomes and Measures<\/strong><\/h3>\n\n\n\nThe primary outcome was the association between POLST order and ICU admission during the last hospitalization of life; the secondary outcome was receipt of a composite of 4 life-sustaining treatments: mechanical ventilation, vasopressors, dialysis, and cardiopulmonary resuscitation. For evaluating factors associated with POLST-discordant care, the outcome was ICU admission contrary to POLST order for medical interventions during the last hospitalization of life.<\/p>\n\n\n\n
Results<\/strong><\/h3>\n\n\n\nAmong 1818 decedents (mean age, 70.8 [SD, 14.7] years; 41% women), 401 (22%) had POLST orders for comfort measures only, 761 (42%) had orders for limited additional interventions, and 656 (36%) had orders for full treatment. ICU admissions occurred in 31% (95% CI, 26%-35%) of patients with comfort-only orders, 46% (95% CI, 42%-49%) with limited-interventions orders, and 62% (95% CI, 58%-66%) with full-treatment orders. One or more life-sustaining treatments were delivered to 14% (95% CI, 11%-17%) of patients with comfort-only orders and to 20% (95% CI, 17%-23%) of patients with limited-interventions orders. Compared with patients with full-treatment POLSTs, those with comfort-only and limited-interventions orders were significantly less likely to receive ICU admission (comfort only: 123\/401 [31%] vs 406\/656 [62%], aRR, 0.53 [95% CI, 0.45-0.62]; limited interventions: 349\/761 [46%] vs 406\/656 [62%], aRR, 0.79 [95% CI, 0.71-0.87]). Across patients with comfort-only and limited-interventions POLSTs, 38% (95% CI, 35%-40%) received POLST-discordant care. Patients with cancer were significantly less likely to receive POLST-discordant care than those without cancer (comfort only: 41\/181 [23%] vs 80\/220 [36%], aRR, 0.60 [95% CI, 0.43-0.85]; limited interventions: 100\/321 [31%] vs 215\/440 [49%], aRR, 0.63 [95% CI, 0.51-0.78]). Patients with dementia and comfort-only orders were significantly less likely to receive POLST-discordant care than those without dementia (23\/111 [21%] vs 98\/290 [34%], aRR, 0.44 [95% CI, 0.29-0.67]). Patients admitted for traumatic injury were significantly more likely to receive POLST-discordant care (comfort only: 29\/64 [45%] vs 92\/337 [27%], aRR, 1.52 [95% CI, 1.08-2.14]; limited interventions: 51\/91 [56%] vs 264\/670 [39%], aRR, 1.36 [95% CI, 1.09-1.68]). In patients with limited-interventions orders, older age was significantly associated with less POLST-discordant care (aRR, 0.93 per 10 years [95% CI, 0.88-1.00]).<\/p>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nConclusions and Relevance<\/strong><\/h3>\n\n\n\nAmong patients with POLSTs and with chronic life-limiting illness who were hospitalized within 6 months of death, treatment-limiting POLSTs were significantly associated with lower rates of ICU admission compared with full-treatment POLSTs. However, 38% of patients with treatment-limiting POLSTs received intensive care that was potentially discordant with their POLST.<\/p>\n","protected":false},"excerpt":{"rendered":"
Original Investigation Caring for the Critically I […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18691"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691\/revisions"}],"predecessor-version":[{"id":18693,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691\/revisions\/18693"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18691"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18691"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18691"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Retrospective cohort study of patients with POLSTs and with chronic illness who died between January 1, 2010, and December 31, 2017, and were hospitalized 6 months or less before death in a 2-hospital academic health care system.<\/p>\n\n\n\n
Exposures<\/strong><\/h3>\n\n\n\nPOLST order for medical interventions (\u201ccomfort measures only\u201d vs \u201climited additional interventions\u201d vs \u201cfull treatment\u201d), age, race\/ethnicity, education, days from POLST completion to admission, histories of cancer or dementia, and admission for traumatic injury.<\/p>\n\n\n\n
Main Outcomes and Measures<\/strong><\/h3>\n\n\n\nThe primary outcome was the association between POLST order and ICU admission during the last hospitalization of life; the secondary outcome was receipt of a composite of 4 life-sustaining treatments: mechanical ventilation, vasopressors, dialysis, and cardiopulmonary resuscitation. For evaluating factors associated with POLST-discordant care, the outcome was ICU admission contrary to POLST order for medical interventions during the last hospitalization of life.<\/p>\n\n\n\n
Results<\/strong><\/h3>\n\n\n\nAmong 1818 decedents (mean age, 70.8 [SD, 14.7] years; 41% women), 401 (22%) had POLST orders for comfort measures only, 761 (42%) had orders for limited additional interventions, and 656 (36%) had orders for full treatment. ICU admissions occurred in 31% (95% CI, 26%-35%) of patients with comfort-only orders, 46% (95% CI, 42%-49%) with limited-interventions orders, and 62% (95% CI, 58%-66%) with full-treatment orders. One or more life-sustaining treatments were delivered to 14% (95% CI, 11%-17%) of patients with comfort-only orders and to 20% (95% CI, 17%-23%) of patients with limited-interventions orders. Compared with patients with full-treatment POLSTs, those with comfort-only and limited-interventions orders were significantly less likely to receive ICU admission (comfort only: 123\/401 [31%] vs 406\/656 [62%], aRR, 0.53 [95% CI, 0.45-0.62]; limited interventions: 349\/761 [46%] vs 406\/656 [62%], aRR, 0.79 [95% CI, 0.71-0.87]). Across patients with comfort-only and limited-interventions POLSTs, 38% (95% CI, 35%-40%) received POLST-discordant care. Patients with cancer were significantly less likely to receive POLST-discordant care than those without cancer (comfort only: 41\/181 [23%] vs 80\/220 [36%], aRR, 0.60 [95% CI, 0.43-0.85]; limited interventions: 100\/321 [31%] vs 215\/440 [49%], aRR, 0.63 [95% CI, 0.51-0.78]). Patients with dementia and comfort-only orders were significantly less likely to receive POLST-discordant care than those without dementia (23\/111 [21%] vs 98\/290 [34%], aRR, 0.44 [95% CI, 0.29-0.67]). Patients admitted for traumatic injury were significantly more likely to receive POLST-discordant care (comfort only: 29\/64 [45%] vs 92\/337 [27%], aRR, 1.52 [95% CI, 1.08-2.14]; limited interventions: 51\/91 [56%] vs 264\/670 [39%], aRR, 1.36 [95% CI, 1.09-1.68]). In patients with limited-interventions orders, older age was significantly associated with less POLST-discordant care (aRR, 0.93 per 10 years [95% CI, 0.88-1.00]).<\/p>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nConclusions and Relevance<\/strong><\/h3>\n\n\n\nAmong patients with POLSTs and with chronic life-limiting illness who were hospitalized within 6 months of death, treatment-limiting POLSTs were significantly associated with lower rates of ICU admission compared with full-treatment POLSTs. However, 38% of patients with treatment-limiting POLSTs received intensive care that was potentially discordant with their POLST.<\/p>\n","protected":false},"excerpt":{"rendered":"
Original Investigation Caring for the Critically I […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18691"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691\/revisions"}],"predecessor-version":[{"id":18693,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691\/revisions\/18693"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18691"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18691"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18691"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
The primary outcome was the association between POLST order and ICU admission during the last hospitalization of life; the secondary outcome was receipt of a composite of 4 life-sustaining treatments: mechanical ventilation, vasopressors, dialysis, and cardiopulmonary resuscitation. For evaluating factors associated with POLST-discordant care, the outcome was ICU admission contrary to POLST order for medical interventions during the last hospitalization of life.<\/p>\n\n\n\n
Results<\/strong><\/h3>\n\n\n\nAmong 1818 decedents (mean age, 70.8 [SD, 14.7] years; 41% women), 401 (22%) had POLST orders for comfort measures only, 761 (42%) had orders for limited additional interventions, and 656 (36%) had orders for full treatment. ICU admissions occurred in 31% (95% CI, 26%-35%) of patients with comfort-only orders, 46% (95% CI, 42%-49%) with limited-interventions orders, and 62% (95% CI, 58%-66%) with full-treatment orders. One or more life-sustaining treatments were delivered to 14% (95% CI, 11%-17%) of patients with comfort-only orders and to 20% (95% CI, 17%-23%) of patients with limited-interventions orders. Compared with patients with full-treatment POLSTs, those with comfort-only and limited-interventions orders were significantly less likely to receive ICU admission (comfort only: 123\/401 [31%] vs 406\/656 [62%], aRR, 0.53 [95% CI, 0.45-0.62]; limited interventions: 349\/761 [46%] vs 406\/656 [62%], aRR, 0.79 [95% CI, 0.71-0.87]). Across patients with comfort-only and limited-interventions POLSTs, 38% (95% CI, 35%-40%) received POLST-discordant care. Patients with cancer were significantly less likely to receive POLST-discordant care than those without cancer (comfort only: 41\/181 [23%] vs 80\/220 [36%], aRR, 0.60 [95% CI, 0.43-0.85]; limited interventions: 100\/321 [31%] vs 215\/440 [49%], aRR, 0.63 [95% CI, 0.51-0.78]). Patients with dementia and comfort-only orders were significantly less likely to receive POLST-discordant care than those without dementia (23\/111 [21%] vs 98\/290 [34%], aRR, 0.44 [95% CI, 0.29-0.67]). Patients admitted for traumatic injury were significantly more likely to receive POLST-discordant care (comfort only: 29\/64 [45%] vs 92\/337 [27%], aRR, 1.52 [95% CI, 1.08-2.14]; limited interventions: 51\/91 [56%] vs 264\/670 [39%], aRR, 1.36 [95% CI, 1.09-1.68]). In patients with limited-interventions orders, older age was significantly associated with less POLST-discordant care (aRR, 0.93 per 10 years [95% CI, 0.88-1.00]).<\/p>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nConclusions and Relevance<\/strong><\/h3>\n\n\n\nAmong patients with POLSTs and with chronic life-limiting illness who were hospitalized within 6 months of death, treatment-limiting POLSTs were significantly associated with lower rates of ICU admission compared with full-treatment POLSTs. However, 38% of patients with treatment-limiting POLSTs received intensive care that was potentially discordant with their POLST.<\/p>\n","protected":false},"excerpt":{"rendered":"
Original Investigation Caring for the Critically I […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18691"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691\/revisions"}],"predecessor-version":[{"id":18693,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18691\/revisions\/18693"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18691"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18691"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18691"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n