{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T16:03:23Z","timestamp":1740153803869,"version":"3.37.3"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS023796"],"award-info":[{"award-number":["R01HS023796"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Background: Portable Orders for Life-Sustaining Treatment (POLST) are increasingly utilized to assist patients approaching the end of life in documenting goals of care. We evaluated the association of POLST, resource utilization, and costs to 1 year among injured older adults requiring emergency services.Methods: This was a retrospective cohort of injured older adults \u226565 years with continuous Medicare fee-for-service coverage transported by emergency medical services (EMS) in 2011 across 4 counties in Oregon. Data sources included EMS, Medicare claims, vital statistics, and state POLST, inpatient and trauma registries. Outcomes included hospital admission, receipt of aggressive medical interventions, costs, and hospice use. We matched patients on patient characteristics and comorbidities to control for bias.Results: We included 2116 patients of which 484 (22.9%) had a POLST form prior to 911 contact. Of POLST patients, 136 (28.1%) had orders for full treatment, 194 (40.1%) for limited interventions, and 154 (31.8%) for comfort measures. There were no significant associations for care during the index event. However, in the year after the index event, patients with care limitations had higher adjusted hospice use (limited interventions OR 1.7 [95% CI: 1.2\u20132.6]; comfort OR, 2.0 [95% CI: 1.3\u20133.0]) and lower adjusted post-discharge costs (no POLST, $32,399 [95% CI: 30,041\u201334,756]; limited interventions, $18,729 [95% CI: 12,913\u201324,545]; and comfort $15,593 [95% CI: 12,091\u201319,095]). There were no significant associations for all other outcomes.Conclusions: Care limitations specified in POLST forms among injured older adults transported by EMS are associated with increased use of hospice and decreased costs to 1 year.<\/jats:p>","DOI":"10.1093\/gerona\/glaa230","type":"journal-article","created":{"date-parts":[[2020,9,11]],"date-time":"2020-09-11T04:24:05Z","timestamp":1599798245000},"page":"1686-1691","source":"Crossref","is-referenced-by-count":1,"title":["End-of-Life Orders, Resource Utilization, and Costs Among Injured Older Adults Requiring Emergency Services"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5542-1425","authenticated-orcid":false,"given":"Amber L","family":"Lin","sequence":"first","affiliation":[{"name":"Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig","family":"Newgard","sequence":"additional","affiliation":[{"name":"Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron B","family":"Caughey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Malveau","sequence":"additional","affiliation":[{"name":"Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abby","family":"Dotson","sequence":"additional","affiliation":[{"name":"Oregon POLST Registry, Department of Emergency Medicine, Oregon Health & Science University, Portland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Eckstrom","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,9,10]]},"reference":[{"author":"Oregon POLST History.","key":"2021081309131455600_CIT0001"},{"issue":"7","key":"2021081309131455600_CIT0002","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1111\/jgs.12889","article-title":"Association between Physician Orders for Life-Sustaining Treatment for scope of treatment and in-hospital death in Oregon","volume":"62","author":"Fromme","year":"2014","journal-title":"J Am Geriatr Soc"},{"issue":"1","key":"2021081309131455600_CIT0003","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1001\/jama.2011.1956","article-title":"POLST Registry do-not-resuscitate orders and other patient treatment preferences","volume":"307","author":"Fromme","year":"2012","journal-title":"J Am Med Assoc"},{"issue":"4","key":"2021081309131455600_CIT0004","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.annemergmed.2013.09.004","article-title":"Concordance of out-of-hospital and emergency department cardiac arrest resuscitation with documented end-of-life choices in Oregon","volume":"63","author":"Richardson","year":"2014","journal-title":"Ann Emerg Med"},{"issue":"10","key":"2021081309131455600_CIT0005","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1016\/j.parkreldis.2015.08.021","article-title":"Life-sustaining treatment orders, location of death and co-morbid conditions in decedents with Parkinson\u2019s disease","volume":"21","author":"Tuck","year":"2015","journal-title":"Parkinsonism Relat 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