title: Implementation of Physician Orders for Life Sustaining Treatment in nursing homes in California: evaluation of a novel statewide dissemination mechanism.
abstract: BACKGROUND
  Implementing Physician Orders for Life Sustaining Treatment (POLST) forms aims to improve communication of life-sustaining treatment preferences across care venues. California enabled this clinical tool in 2009, and a novel intervention of community coalitions was undertaken to advance POLST in localities around the state. Coalitions engaged facilities, including nursing homes (NHs), to foster POLST adoption. Eighteen months after introduction of POLST, we studied POLST implementation in California NHs.
  
  
  METHODS
  NHs randomly selected in coalition and non-coalition areas were mailed surveys about POLST preparation and use in 2010. Coalitions identified which NHs they worked with.
  
  
  RESULTS
  Of 546 NHs surveyed, 143 (52 %) in coalition areas and 141 (52 %) in non-coalition areas responded. In 82 % of responding NHs, staff received POLST education and 59 % of NHs reported having a formal policy on handling POLST. Two-thirds of NHs had admitted a resident with a POLST, and 15 % of newly admitted residents over the past month had a POLST (range 0-100 %). Eighty-one percent of NHs had completed a POLST with a resident. Fifty-four percent of residents were estimated to have a POLST (range 0-100 %) (coalition area NHs 60 % vs. non- coalition area NHs 48 %, p = 0.02). Within coalition areas, NHs that had worked with coalitions were more likely to have completed a POLST with a resident after admission than NHs that had not worked with coalitions. Few NHs (7 %) reported difficulty following POLST orders, but 38 % noted difficulty involving physicians in POLST completion.
  
  
  CONCLUSIONS
  Less than 2 years after introduction, many California nursing homes report using POLST, although some NHs reported no experience. A novel community coalition intervention facilitated POLST implementation.
authors.affiliation: UCLA Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza #309, Los Angeles, CA 90024, USA. nwenger@mednet.ucla.edu
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
authors.forename: Judy
authors.initials: J
authors.lastname: Citko
authors.forename: Kate
authors.initials: K
authors.lastname: O'Malley
authors.forename: Allison
authors.initials: A
authors.lastname: Diamant
authors.forename: Karl
authors.initials: K
authors.lastname: Lorenz
authors.forename: Victor
authors.initials: V
authors.lastname: Gonzalez
authors.forename: Derjung M
authors.initials: DM
authors.lastname: Tarn
mesh_terms: D024362:Advance Directive Adherence / Q000706:statistics & numerical data; D016223:Advance Directives / Q000706:statistics & numerical data*; D002140:California; D003142:Communication; D019538:Health Care Surveys; D006282:Health Personnel / Q000193:education; D006302:Health Services Research / Q000379:methods; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*; D057240:Patient Preference / Q000706:statistics & numerical data; D016414:Resuscitation Orders; D013727:Terminal Care / Q000458:organization & administration*