KMID : 0387320230330010019
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Korean Journal of Health Policy and Administration 2023 Volume.33 No. 1 p.19 ~ p.28
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Association of Physician Orders for Life Sustaining Treatment Completion and Healthcare Utilization before Death
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Kim Eun-Ji
Kim Hong-Soo
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Abstract
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Background: With the enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act in February2018, legal guidelines for physician orders for life-sustaining treatment (POLST) were presented. This study was conducted toanalyze the association of writing POLST on the use of health care before death.
Methods: The study analyzed the electronic medical records and POLSTs of 1,003 adult patients who died at a tertiary hospitallocated in Seoul from February 4, 2018 to February 4, 2019.
Results: Of the deaths, 80% (n=804) completed POLST. Among patients who completed POLST before death, 51% (n=412) werewritten 1?7 days before death, and only 31% (n=246) were completed by patients themselves. 99% (n=799) decided to withdraw orwithhold cardiopulmonary resuscitation. As a result of analyzing the effect of POLST on medical use before death, it was found thatPOLST and inpatient cost had a significant negative correlation, and POLST completion significantly reduced death in the intensivecare unit (ICU). However, both inpatient costs and death at ICU increased when the POLST was completed by surrogatedecision-makers rather than patients themselves.
Conclusion: The enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act provided a legal basisfor withdrawing and withholding meaningless life-sustaining treatment. By specifying the treatment to be received at the end of one¡¯slife through the POLST, inpatient treatment costs and death at the ICU were decreased. However, the frequent decision-making bythe surrogates and completion of POLST close to death may hinder the original purpose of the law.
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KEYWORD
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Life-sustaining treatment, Physician orders for life-sustaining treatment, Healthcare utilization
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