title: Implementing physician orders for life-sustaining treatment in California hospitals: factors associated with adoption.
abstract: Physician Orders for Life-Sustaining Treatment (POLST) is a tool to document and ensure continuity of end-of-life treatment decisions across healthcare settings that became a legal document in California in January 2009. Hospitals were surveyed to evaluate factors associated with uptake of this intervention and whether a grassroots community coalition intervention facilitated dissemination. A mail and telephone survey of all acute care hospitals in California was conducted between August 2011 and January 2012, and community coalition reports of interaction with hospitals and hospital characteristics from the California Office of Statewide Planning and Development and Census ZIP Code Tabulation Areas were analyzed. Of 349 hospitals, 286 (81.9%) responded to the survey. Sixty-five percent of hospitals had a policy about POLST, 87% had available blank POLST forms, 84% had educated staff, and 94% reported handling POLST properly in the emergency department and on admission. In multivariable analyses, hospitals in poor areas and for-profit (vs nonprofit) hospitals were less likely to stock blank POLST forms and to have educated staff, and hospitals with community coalition interaction and in wealthier areas were more likely to handle POLST forms correctly. Although POLST is widely used in California, a significant minority of hospitals remain unprepared 3 years after implementation. Efforts to improve implementation should emphasize dissemination in poorer areas and in for-profit hospitals.
authors.affiliation: Division of General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, California 90095, USA.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sugiyama
authors.forename: David
authors.initials: D
authors.lastname: Zingmond
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
authors.forename: Allison
authors.initials: A
authors.lastname: Diamant
authors.forename: Kate
authors.initials: K
authors.lastname: O'Malley
authors.forename: Judy
authors.initials: J
authors.lastname: Citko
authors.forename: Victor
authors.initials: V
authors.lastname: Gonzalez
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
mesh_terms: D024362:Advance Directive Adherence / Q000331:legislation & jurisprudence*; D002140:California; D003625:Data Collection; D004282:Documentation; D006265:Health Care Coalitions; D006284:Health Plan Implementation / Q000331:legislation & jurisprudence*; D006801:Humans; D033181:Information Dissemination; D007318:Inservice Training; D008020:Life Support Care / Q000331:legislation & jurisprudence*
keywords: POLST; advance care planning; community interventions