|
KMID : 0387320230330010019
|
|
Korean Journal of Health Policy and Administration
2023 Volume.33 No. 1 p.19 ~ p.28
|
|
|
Association of Physician Orders for Life Sustaining Treatment Completion and Healthcare Utilization before Death
|
|
Kim Eun-Ji
Kim Hong-Soo
|
|
|
Abstract
|
|
|
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.
|
|
|
KEYWORD
|
|
|
Life-sustaining treatment, Physician orders for life-sustaining treatment, Healthcare utilization
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
 
|
|