title: The POLST program: a retrospective review of the demographics of use and outcomes in one community where advance directives are prevalent.
abstract: OBJECTIVE
  Determine the use and utility of the Physician Orders for Life-Sustaining Treatment (POLST) program in a community where powers of attorney for health care (POAHCs) are prevalent.
  
  
  METHODS
  A retrospective review of medical record and death certificate data of 400 adults who died between September 1, 2007, and March 31, 2008, in the La Crosse County, Wisconsin community. Demographic and cause-of-death data were collected from death certificates. Information about POAHC, POLST forms, and medical treatments provided in the last 30 days of life were abstracted from decedents' medical records.
  
  
  RESULTS
  Sixty-seven percent of decedents had a POLST form, whereas 22% had POAHC alone. In comparison with decedents with POAHC alone, decedents with a POLST form were significantly older (83 versus 77 years, p<0.001), more likely to die in a nursing home than in a hospital (p<0.001), and more likely to die from a terminal or chronic illnesses (97%). Decedents with POLST orders for higher levels of medical treatment received more treatment, and in only two cases was there evidence that treatment was discrepant with POLST orders. In 31% of all POLST forms, the person appointed in the POAHC consented to the POLST orders.
  
  
  CONCLUSIONS
  POLST can be a highly effective program to ensure that patient preferences are known and honored in all settings. POAHCs are valuable because they identify appropriate surrogates when patients are incapacitated.
authors.affiliation: Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin 54601, USA. bjhammes@gundluth.org
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Hammes
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Rooney
authors.forename: Jacob D
authors.initials: JD
authors.lastname: Gundrum
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hickman
authors.forename: Nickijo
authors.initials: N
authors.lastname: Hager
mesh_terms: D000328:Adult; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D003644:Death Certificates; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016414:Resuscitation Orders; D012189:Retrospective Studies; D014922:Wisconsin