Variation in Decisions to Forgo Life-Sustaining Therapies in US ICUs

Quill, Caroline M.; Ratcliffe, Sarah J.; Harhay, Michael O.; Halpern, Scott D.

doi:10.1378/chest.13-2529

Cited by 120 publications

(123 citation statements)

References 38 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…Th e present results cannot be used to determine whether this association is directly related to the lack of physicians and diff erences in interactions between daytime and nighttime staff or is mediated by unmeasured patient or ICU characteristics. Nonetheless, the fi nding that physician staffi ng models may be associated with diff erences in end-of-life care, as suggested by this study and others, 19,20 highlights the need to measure practices of withholding and withdrawing life support in all studies comparing mortality among ICUs with diff erent organizational characteristics.…”

Section: Discussionmentioning

confidence: 58%

Nighttime Intensivist Staffing, Mortality, and Limits on Life Support

Kerlin

Harhay

Kahn

et al. 2015

Chest

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 58%

Nighttime Intensivist Staffing, Mortality, and Limits on Life Support

Kerlin

Harhay

Kahn

et al. 2015

Chest

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 77%

“…This finding stands in stark contrast to a plethora of prior data showing disparity in advance care planning and end-of-life care across ethnicities. [15][16][17] These findings show that a broad, rather complex public health intervention can be disseminated widely and effectively in a relatively brief period of time across a large, racially diverse state.The California POLST dissemination was a broad-based statewide effort that included a coordinated effort among stakeholders throughout the state, a coordinating organization supported with funding from a grant-making organization focused on healthcare, combined with a grassroots initiative. California state law (Assembly Bill 3000) in 2008 authorized the use of POLST throughout the state, effective January 1, 2009.…”

mentioning

confidence: 77%

Use of the Physician Orders for Life-Sustaining Treatment among California Nursing Home Residents

Jennings

Zingmond²,

Louie³

et al. 2016

J GEN INTERN MED

View full text Add to dashboard Cite

BACKGROUND: Physician Orders for Life-Sustaining Treatment (POLST) is a tool that facilitates the elicitation and continuity of life-sustaining care preferences. POLST was implemented in California in 2009, but how well it disseminated across a large, racially diverse population is not known and has implications for end-of-life care. OBJECTIVE: To evaluate the use of POLST among California nursing home residents, including variation by resident characteristics and by nursing home facility. DESIGN: Observational study using California Minimum Data Set Section S. PARTICIPANTS: A total of 296,276 people with a stay in 1,220 California nursing homes in 2011. MAIN MEASURES:The proportion of residents with a completed POLST (containing a resuscitation status order and resident/proxy and physician signatures) and relationship to resident characteristics; change in POLST use during 2011; and POLST completion and unsigned forms within nursing homes. KEY RESULTS: During 2011, POLST completion increased from 33 to 49 % of California nursing home residents. Adjusting for age and gender using a mixed-effects logistic model, long-stay residents were more likely than short-stay residents to have a completed POLST [OR = 2.36 (95 % CI 2.30, 2.42)]; severely cognitively impaired residents were less likely than unimpaired to have a completed POLST [OR = 0.89 (95 % CI 0.87, 0.92)]; and there was little difference by functional status. There was no difference in POLST completion among White non-Hispanic, Black, and Hispanic residents. Variation in POLST completion among nursing homes far exceeded that attributable to resident characteristics with 40 % of facilities having ≥80 % of long-stay residents with a completed POLST, while 20 % of facilities had ≤10 % of long-stay residents with a completed POLST. Thirteen percent of nursing home residents had a POLST containing a resuscitation preference but lacked a signature, rendering the POLST invalid. CONCLUSIONS: Statewide nursing home data show broad uptake of POLST in California without racial disparity. However, variation in POLST completion among nursing homes identifies potential areas for quality improvement.KEY WORDS: end-of-life care; nursing home; long-term care; quality improvement. J Gen Intern Med 31(10):1119-26 DOI: 10.1007/s11606-016-3728-9 © Society of General Internal Medicine 2016 INTRODUCTIONPhysician Orders for Life-Sustaining Treatment (POLST) facilitates elicitation of life-sustaining treatment preferences from patients and is designed to improve the transition of these preferences, in the form of physician orders, across care settings. POLST captures preferences concerning cardiopulmonary resuscitation, overall aggressiveness of care, hospital transfer, and artificial nutrition. 1 The document is particularly useful for residents of nursing facilities because many residents live in compromised health states and would not desire burdensome treatments 2 and also because it is common for nursing home residents to transition to the emergency room and the hospital 3 wh...

show abstract

“…IMPACT data have been shown to be highly reliable, and ICUs are largely representative of US ICUs. 32 As in prior studies, 18,19,25,[34][35][36] we used a specially prepared version of this dataset in which ICU and hospital admission and discharge dates and times were available for all patients; more detailed patient data were collected on a random sample of 50% to 100% of patients.…”

Section: Data Sourcementioning

confidence: 99%

Assessing the Utility of ICU Readmissions as a Quality Metric

Brown

Ratcliffe

Halpern

2015

Chest

Self Cite

View full text Add to dashboard Cite

BACKGROUND: ICU readmissions are associated with increased mortality and costs; however, it is unclear whether these outcomes are caused by readmissions or by residual confounding by illness severity. An assessment of temporal changes in ICU readmission in response to a specific policy change could help disentangle these possibilities. We sought to determine whether ICU readmission rates changed aft er 2003 Accreditation Council for Graduate Medical Education Resident Duty Hours reform ("reform") and whether there were temporally corresponding changes in other ICU outcomes.

show abstract

Variation in Decisions to Forgo Life-Sustaining Therapies in US ICUs

Abstract: BACKGROUND:Th e magnitude and implication of variation in end-of-life decision-making among ICUs in the United States is unknown.

Cited by 120 publications

References 38 publications

Nighttime Intensivist Staffing, Mortality, and Limits on Life Support

Nighttime Intensivist Staffing, Mortality, and Limits on Life Support

Use of the Physician Orders for Life-Sustaining Treatment among California Nursing Home Residents

Assessing the Utility of ICU Readmissions as a Quality Metric

Contact Info

Product

Resources

About