POLST Care Intensity Directly Impacts Hospital Utilization

Background: Physician Orders for Life Sustaining Treatment (POLST) documents specify the desired intensity of care a person wishes to receive, which medical professionals generally follow when the individual becomes ill. The impact of POLST forms on hospital utilization remains unclear. Objective: To investigate the relationship between POLST—both its presence and the type of instructions within it—and hospital utilization among nursing home residents in California. Design: Retrospective cohort study. Methods: The study linked information from the Minimum Data Set to POLST documentation (California Section S), Medicare line item claims and Medicare Beneficiary Summary File between 2011 and 2016. The main outcomes were (a) hospitalization, (b) days in the hospital, and (c) days spent in the ICU, adjusting for resident and nursing home characteristics. Results: 1,112,834 residents had a completed and signed POLST document. Of the resident-time (in person-years), 29.6% had a more...