Implementing a Care Planning System: How to Fix the Most Pervasive Errors in Health Care

Hammes, Bernard J.; Briggs, Linda; Silvester, William; Wilson, Kristina; Schettle, Sue; Maycroft, John R.; Sandoval, Julie; Orders, Ann E.; Stern, Melissa

doi:10.1007/978-1-4939-0407-5_12

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…However, the finding that 41% of orders on POLST and 65% of orders in non-POLST charts were discordant with current preferences indicates a clear need for increased attention to the quality of advance care planning in nursing facilities through a system redesign that includes systems change and clinician training. 47 Additional analyses are planned to evaluate variables that contribute to POLST concordance to support the development of interventions.…”

Section: Discussionmentioning

confidence: 99%

Do Life-sustaining Treatment Orders Match Patient and Surrogate Preferences? The Role of POLST

et al. 2020

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BACKGROUND: It is essential to high-quality medical care that life-sustaining treatment orders match the current, values-based preferences of patients or their surrogate decision-makers. It is unknown whether concordance between orders and current preferences is higher when a POLST form is used compared to standard documentation practices. OBJECTIVE: To assess concordance between existing orders and current preferences for nursing facility residents with and without POLST forms. DESIGN: Chart review and interviews. SETTING: Forty Indiana nursing facilities (29 where POLST is used and 11 where POLST is not in use). PARTICIPANTS: One hundred sixty-one residents able to provide consent and 197 surrogate decision-makers of incapacitated residents with and without POLST forms. MAIN MEASUREMENTS: Concordance was measured by comparing life-sustaining treatment orders in the medical record (e.g., orders about resuscitation, intubation, and hospitalization) with current preferences. Concordance was analyzed using population-averaged binary logistic regression. Inverse probability weighting techniques were used to account for non-response. We hypothesized that concordance would be higher in residents with POLST (n = 275) in comparison to residents without POLST (n = 83). KEY RESULTS: Concordance was higher for residents with POLST than without POLST (59.3% versus 34.9%). In a model adjusted for resident, surrogate, and facility characteristics, the odds were 3.05 times higher that residents with POLST had orders for life-sustaining treatment match current preferences in comparison to residents without POLST (OR 3.05 95% CI 1.67-5.58, p < 0.001). No other variables were significantly associated with concordance. CONCLUSIONS: Nursing facility residents with POLST are significantly more likely than residents without POLST to have concordance between orders in their medical records and current preferences for life-sustaining treatments, increasing the likelihood that their treatment preferences will be known and honored. However, findings indicate further systems change and clinical training are needed to improve POLST concordance.

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Section: Discussionmentioning

confidence: 99%

Do Life-sustaining Treatment Orders Match Patient and Surrogate Preferences? The Role of POLST

et al. 2020

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“…Failure to know and honor resident preferences is a serious medical error . Fixing these errors necessitates a concerted, systematic effort …”

Section: Discussionmentioning

confidence: 99%

An Interim Analysis of an Advance Care Planning Intervention in the Nursing Home Setting

Hickman

Unroe

Ersek

et al. 2016

J American Geriatrics Society

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“…Any intervention implemented will require further research to evaluate its effect on promoting person-centered, goaldirected care for all seriously ill persons. [58][59][60][61] Incident serious illness defined as first diagnosis of a serious medical condition (e.g., metastatic cancer) or loss of independence in one or more ADLs. 43 Odds ratios represent exponentiated coefficients from independent multivariable logistic regressions on full sample and each stratum of death probability.…”

Section: Figmentioning

confidence: 99%

Prospective Identification of Patients at Risk for Unwarranted Variation in Treatment

Kelley

Bollens‐Lund

Covinsky

et al. 2018

Journal of Palliative Medicine

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Implementing a Care Planning System: How to Fix the Most Pervasive Errors in Health Care

Cited by 3 publications

References 21 publications

Do Life-sustaining Treatment Orders Match Patient and Surrogate Preferences? The Role of POLST

Do Life-sustaining Treatment Orders Match Patient and Surrogate Preferences? The Role of POLST

An Interim Analysis of an Advance Care Planning Intervention in the Nursing Home Setting

Prospective Identification of Patients at Risk for Unwarranted Variation in Treatment

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