People diagnosed with a serious illness or frailty in the state of Oregon are more likely to have their end-of-life care wishes honored, and, consequently, less likely to be hospitalized. These individuals are more likely to use home hospice services compared with Washington state and the rest of the country, according to data published in the New England Journal of Medicine.
This data looked at utilization trends for Medicare fee-for-service, including the percentage of patients who died at home, died in hospice care, were admitted to an intensive care unit in the last 30 days of life, or were discharged home after hospitalization in the last 30 days of life. The trends for Oregon were much different than the other states – Nearly 2/3 of Oregonians die at home, compared with 39.6 percent of Americans nationwide. Intensive care unit use in the last 30 days of life in Oregon was 18.2 percent, compared with 23 percent in Washington state and 28.5 percent nationwide. Those who were hospitalized in the last month of life were more likely to be discharged home in Oregon (73.5 percent) than in Washington state or nationwide ( 63.5 percent in Washington and 54.2 percent nationwide).
Oregon has integrated end-of-life care initiatives throughout all levels of their health care systems with the creation of the POLST Program. This form records and honors patients’ wishes to have or limit medical treatments near the end-of-life. Susan Tolle, M.D., Director of the OHSU Center for Ethics in Health Care co-led the creation of the Physician Orders for Life-Sustaining Treatment. The POLST Program allows patients with terminal illness and frailty to have meaningful conversations with their physician in which they can discuss goals of care and document patient wishes. This form is a medical order that can be honored across settings of care and by emergency medical technicians and hospitals.
The exact reason(s) are still unknown why there are such differences in end-of-life care in Oregon compared with other states, but the thought is it reflects the complexity and intensity of the initiatives developed to support the POLST as well as a more comprehensive plan of care to honor a person’s personal preferences. End-of-life care planning is important-it should be done before a person becomes too sick. Have these discussions with your family and physician, don’t wait until it’s too late. By deciding what end-of-life care best suits your needs when you are healthy, you can help those close to you make the right choices when the time comes. This not only respects your values, but also may give your loved ones comfort.