Evidence map›Paper›PMID 37092747›Full record

ArticleJournal of the American Geriatrics Society2023

Changes over time in POLST use and content by race and ethnicity among California nursing home residents.

David S Zingmond, David Powell, Lee A Jennings, Li-Jung Liang, Jose J Escarce, Punam Parikh, Neil S Wenger

Abstract read
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In one paragraph

Article in Journal of the American Geriatrics Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

David S ZingmondDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
David PowellRAND Health, Santa Monica, California, USA.
Lee A JenningsReynolds Section of Geriatrics, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.ORCID 0000-0002-9524-6921
Li-Jung LiangDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Jose J EscarceDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Punam ParikhDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Neil S WengerDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA.ORCID 0000-0002-9884-3967

Funding

Impact of POLST Adoption and of Financial Incentives on Care Receipt and on Intensity of Care Preferences in Nursing Home PatientsR01AG055751 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI ZINGMOND, DAVID SCOTT · 2018 to 2021
$2.6M
NIA NIH HHS 1R01AG055751NIA NIH HHS R01 AG055751
6 · The paper itself

Abstract

backgroundPhysician Orders for Life-Sustaining Treatment (POLST) are commonly used for nursing home (NH) residents. Treatment orders differ across race and ethnicity, presumably related to cultural and socioeconomic variation and levels of access to care and trust. Because national efforts focus on addressing the underpinnings of racial and ethnic differences in treatment (i.e., access to care and trust), we describe POLST use and content by race and ethnicity.

methodsCalifornia requires NHs to document POLST completion and content in the Minimum Data Set. We describe POLST completion and content for all California NH residents from 2011 to 2016 (N = 1,120,376). Adjusting for resident characteristics, we compared changes in completion rate and differences by race and ethnicity in POLST content-orders for cardiopulmonary resuscitation (CPR), do not resuscitate (DNR), CPR with full treatment, DNR with selective treatment or comfort orders, and if unsigned.

resultsPOLST completion increased across all racial and ethnic groups from 2011 to 2016; by 2016, NH residents had a POLST two-thirds or more of the time. In 2011, Black residents had a POLST with a CPR order 30.4% of the time, Hispanic residents 25.6%, and White residents 19.7%. By 2016, this grew to 42.5%, 38.2%, and 28.1%, respectively, with Black and Hispanic residents demonstrating larger increases than White residents (p < 0.001). Increases over time in POLST with CPR and full treatment were greater for Black and Hispanic residents compared to White residents. The increase in POLST with DNR and DNR with Selective treatment and Comfort orders was greater for White compared to Black patients (p < 0.001). Unsigned POLST with CPR and DNR orders decreased across all racial and ethnic groups.

conclusionsRacial and ethnic differences in POLST intensity of care orders increased between 2011 and 2016 suggesting that efforts to mitigate factors underlying differences were ineffective. Studies of newer POLST data are imperative.

Indexed as

Advance Care PlanningAdvance DirectivesCaliforniaEthnicityHumansNursing HomesResuscitation Ordersend-of-life carelong-term carenursing homePOLSTrace disparity

Identifiers

PMID37092747
PMCPMC10524124

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.