Here is the PICO analysis for the twenty-eighth uploaded article:
✅ PICO Analysis
Full Article Title:
Implementation of Physician Orders for Life Sustaining Treatment in Nursing Homes in California: Evaluation of a Novel Statewide Dissemination Mechanism
Type of Study:
Cross-sectional survey evaluation of a statewide intervention
Journal and Year:
Journal of General Internal Medicine (2013); 28(1):51–57
DOI: 10.1007/s11606-012-2178-2
P – Population
- Setting:
- Nursing homes across California
- Participants:
- Directors of Nursing or Administrators at 546 randomly selected nursing homes
- Context:
- Evaluating POLST (Physician Orders for Life-Sustaining Treatment) use 18 months after state-wide legislative adoption in 2009
I – Intervention
- Nature of Intervention:
- Implementation of the POLST form across California nursing homes
- A novel community-based dissemination model: grassroots community coalitions in 18 counties were supported to implement and educate about POLST
- Coalitions provided training, policy guidance, and educational materials to nursing homes
C – Comparison
- Control:
- Nursing homes in non-coalition areas (i.e., regions where community coalitions were not active)
- Also compared within coalition areas: nursing homes that received direct interaction with coalitions vs. those that did not
- Some analyses looked at level of coalition involvement (none, low, moderate, high)
O – Outcomes
Structural Outcomes:
- 59% of nursing homes had a formal POLST policy
- 70% had a designated “POLST champion”
- 82% had conducted staff education on POLST
- Role play and case discussion were more common in coalition areas (53%) than non-coalition areas (36%, p=0.01)
Usage Outcomes:
- 81% of all nursing homes had completed a POLST with a resident
- Mean percentage of residents with a POLST:
- 53.7% overall
- 59.8% in coalition areas vs. 48.0% in non-coalition areas (p = 0.02)
- 69% had admitted at least one resident with a pre-existing POLST
- Nursing homes that had worked with coalitions were significantly more likely to complete POLSTs with new residents (92.1% vs. 76.5%, p = 0.015)
Reported Barriers:
- 38% had difficulty obtaining physician participation in POLST completion
- 34% reported difficulty getting physician signatures
- 21% had trouble interpreting POLST orders for treatment decisions
- 62% reported challenges retrieving original POLST forms from other facilities
- Only 7% had difficulty following POLST orders once available
Outcome Classification
- Person-centred outcomes:
- Indirectly inferred: higher uptake of POLST suggests more consistent alignment with resident treatment preferences
- Process outcomes:
- Staff training, policy development, use of structured conversations, and documentation of preferences
- Health system outcomes:
- Suggestive evidence of reduced variation and greater goal-concordant care; need for further evaluation of impact on transfers, hospitalisations, and care intensity
Summary Conclusion
This statewide evaluation found that within 18 months of the legislative introduction of POLST in California, over 80% of nursing homes had implemented POLST, with more than half of residents having completed forms. Community coalitions significantly enhanced adoption, with a “dose-response” relationship observed between level of coalition engagement and POLST usage and staff training. While most facilities reported successful uptake, barriers related to physician involvement and document portability remained. The community coalition model proved to be a feasible and effective method for disseminating POLST across a large and diverse healthcare system .
Life In The Slower Lane 
Leave a comment