Center for Health Ethics and Law, West Virginia University, Morgantown, WV.
Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, OR.
J Am Med Dir Assoc. 2017 Sep 1;18(9):810.e5-810.e9. doi: 10.1016/j.jamda.2017.05.015. Epub 2017 Jun 28.
Physician Orders for Life-Sustaining Treatment (POLST) need to be complete and consistent to allow health care personnel to honor patient preferences in a time of emergency. The purpose of our study was to evaluate the quality of POLST completion to guide treatment for level of medical intervention.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study combined data from the Oregon and West Virginia POLST registries for the study period January 1, 2010, through December 31, 2016. All POLST form resuscitation (section A) and level of medical intervention (section B) orders were reviewed.
Percent of POLST form orders in sections A and B with and without contradictions.
During the study period, there were 268,386 POLST forms in the Oregon POLST Registry and 10,122 forms in the West Virginia e-Directive Registry. Of the forms, 99.2% in Oregon and 96.6% in West Virginia contained orders in both sections A and B. There were contradictions on 0.11% of forms from Oregon and 2.53% from West Virginia.
The quality of POLST form completion in the Oregon and West Virginia registries is good with less than 10% of forms lacking orders in sections A and B and containing contradictory orders. This study indicates what type of results are possible with statewide education, likely through POLST Paradigm Programs. Further research is needed to determine the quality of POLST form completion in other states and other factors that contribute to their quality.
医师签署的延续生命治疗医嘱（POLST）必须完整且一致，以便医护人员在紧急情况下尊重患者的意愿。我们的研究目的是评估 POLST 完成质量，以指导按照医疗干预程度进行治疗。
设计、地点和参与者：本横断面研究合并了 2010 年 1 月 1 日至 2016 年 12 月 31 日期间俄勒冈州和西弗吉尼亚州 POLST 注册处的数据。审查了所有 POLST 复苏表（A 节）和医疗干预程度表（B 节）的医嘱。
A 节和 B 节的 POLST 表中存在和不存在矛盾医嘱的百分比。
在研究期间，俄勒冈州 POLST 注册处有 268386 份 POLST 表，西弗吉尼亚州 e-Directive 注册处有 10122 份。其中，俄勒冈州有 99.2%的表格和西弗吉尼亚州有 96.6%的表格同时包含 A 节和 B 节的医嘱。俄勒冈州有 0.11%的表格和西弗吉尼亚州有 2.53%的表格存在矛盾医嘱。
俄勒冈州和西弗吉尼亚州注册处的 POLST 表格填写质量良好，不到 10%的表格在 A 节和 B 节中缺少医嘱，且存在矛盾医嘱。本研究表明，通过全州范围的教育（可能通过 POLST 范式计划）可以达到何种类型的结果。还需要进一步研究以确定其他州的 POLST 表格填写质量以及其他影响其质量的因素。
