title: Physician Treatment Orders in Dutch Nursing Homes.
abstract: OBJECTIVE
  Physician treatment orders (PTOs) prevent burdensome unnecessary medical treatment of frail nursing home patients. The aim was to determine the prevalence of PTOs and time duration between nursing home admittance and PTO completion.
  
  
  METHODS
  Population-based, retrospective cohort study.
  
  
  METHODS
  Nursing homes across the Netherlands.
  
  
  METHODS
  Digital medical records of patients who subsequently were submitted to 14 Dutch nursing homes across The Netherlands were studied between 2010 and 2013. The prevalence's of do-resuscitate, do-not-resuscitate, life-sustaining, and palliative care PTOs and the time intervals between nursing home admittance and documentation of PTOs were measured. Information regarding demographic patient characteristics, type of nursing home ward, and mention of a discussion of PTOs with the patient or caregivers was obtained.
  
  
  RESULTS
  Eighty-two percent of the nursing home patients received a PTO regarding resuscitation, life-sustaining, or palliative care treatment. Twenty-four percent of the patients received a do-resuscitation PTO, 55% received a do-not-resuscitate PTO, 44% a life-sustaining PTO, and 16% a palliative care PTO. The median duration between nursing home admittance and documentation of the first PTO was 1 day. Most nursing home patients had PTOs within 1 week after admittance.
  
  
  CONCLUSIONS
  A minority (18%) of Dutch nursing home patients has no documented PTOs during their nursing home stay, which could have negative effects on end-of-life care of nursing home residents.
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research VU Medical Center, Amsterdam, The Netherlands. Electronic address: h.bouwstra@gmail.com.
authors.forename: Hylco
authors.initials: H
authors.lastname: Bouwstra
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: Smalbrugge
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Cees M
authors.initials: CM
authors.lastname: Hertogh
mesh_terms: D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D009735:Nursing Homes; D010166:Palliative Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D012189:Retrospective Studies
keywords: Physician treatment order; advance care planning; long-term care facility; nursing home; palliative care; resuscitation