Date

July 2013

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Study Objective: Resuscitation measures should be guided by prior patient choices regarding their end-of-life care when they exist. We evaluate the concordance of prehospital and emergency department (ED) care provided for patients in out-of-hospital cardiac arrest (OHCA) with a statewide registry of resuscitation orders in Oregon. Methods: This was a retrospective cohort study of patients found by EMS providers in OHCA in five counties in 2010. We used probabilistic linkage to match patients found in OHCA with previously signed documentation of end-of-life decisions in the Oregon Physician Orders for Life-Sustaining Treatment (POLST) registry. We evaluated resuscitation interventions in the field, ED transport, and hospital admission. We used logistic regression analysis to examine patient-based factors associated with presence of a signed POLST form. Results: There were 1,577 patients found in OHCA in this cohort, of whom 82 had a previously signed POLST form. When compared to patients with POLST orders to attempt resuscitation, patients with POLST do-not-resuscitate (DNR) orders had less field resuscitation (22% versus 84%; difference 62%, 95% CI 45%-79%), ED transport (12% versus 63%; difference 51%; 95% CI 31%-70%) and hospital admission (6% versus 38%; difference 32%, 95% CI 13%-50%). Older patients, non-white patients, and patients not living in private residences were most likely to have an active POLST form. Conclusions: In this sample of patients in OHCA, prehospital and ED care were generally concordant with previously documented end-of-life orders by emergency care providers. These findings suggest that a statewide POLST program can effectively guide providers with patient pre-existing end-of-life choices in the setting of critical illness.

Identifier

doi:10.6083/M48S4MX9

School

School of Medicine

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