Physician Orders for Life-Sustaining Treatment (POLST) can effectively transmit decisions about aggressiveness of care for nursing home (NH) residents across time and settings. However, POLST requires valid completion, continuity, and availability to ensure care consistent with goals. These aspects of POLST use have been studied only in narrow samples over brief periods or through registries. California implemented POLST in 2009 and since 2011 California NHs were required to report POLST completion and content in a supplemental section of the Minimum Data Set (MDS). We used MDS 2011–2016 linked to California Section S to describe POLST completion, cardiopulmonary resuscitation (CPR) and do not resuscitate (DNR) orders, invalid POLST documents, and switches in POLST content across the population of California NH residents.
This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.
Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/research-integrity.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.