# Impact of POLST Adoption and of Financial Incentives on Care Receipt and on Intensity of Care Preferences in Nursing Home Patients

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA LOS ANGELES · 2020 · $335,710

## Abstract

ABSTRACT
Burdensome transitions – increases in intensity of care at the end of life (EOL) – are not necessarily desired by
patients or their advocates. Patients with Alzheimer’s disease and its related Dementias (AD/ADRD) frequently
require the agency of their proxies (whether family or other decision makers) to ensure that their wishes are
met. Prior work has shown that existence of an advanced directive or other forms of advanced care planning is
associated with lower rates of burdensome transitions at EOL in a national nursing home (NH) population. Use
of POLST has been associated with lower ICU use among patients with dementia at EOL. NH quality – as
measured by the CMS Five Star Rating in NH Compare – is associated with greater completion of POLST
among long term NH patients, most of who screen for significant cognitive impairment.
Patients with AD/ADRD represent a challenging, but appropriate population for POLST implementation to
reduce burdensome transitions at the end of life. The goal of POLST is to codify patient’s wishes in a single
document that captures the physician’s specific orders for care intensity. The goal is for medical providers to
follow these orders. Patients with AD/ADRD are highly dependent on others to complete and maintain POLSTs
that reflect their wishes.
In preliminary work, we have shown that NH quality is associated with POLST completion. It is less clear if NH
quality impacts how POLST is completed within NH among patients with AD/ADRD. Do lower quality NHs
complete POLSTs that reflect patient wishes and / or the best judgement of their proxies? Or, are lower quality
NHs defaulting to higher intensity care when POLSTs are completed, resulting in patients with AD/ADRD
undergoing more burdensome transitions and receiving higher intensity care at the end of life?
In this administrative supplement, we will investigate the impact of NH quality on care preferences and care
delivery for individuals with AD/ADRD with significant cognitive impairment at the end life in California (2011 to
2018) in order to specifically address the following specific aims:
 1. Determine the impact of overall and constituent characteristics of NH quality on POLST completion and
 patient preferences among LTC patients with AD/ADRD at the end-of-life.
 2. Determine the impact of NH quality on burdensome transitions at the end-of-life among LTC patients
 with AD/ADRD at the end-of-life accounting for POLST completion.
This supplement will specifically address how NH quality influences the completion and recording of patient
preferences in one type of ACP instrument – the POLST – and how NH quality and POLST interact to
influence intensification of care at EOL for patients with AD/ADRD.

## Key facts

- **NIH application ID:** 10120540
- **Project number:** 3R01AG055751-03S1
- **Recipient organization:** UNIVERSITY OF CALIFORNIA LOS ANGELES
- **Principal Investigator:** DAVID Scott ZINGMOND
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $335,710
- **Award type:** 3
- **Project period:** 2018-04-15 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10120540

## Citation

> US National Institutes of Health, RePORTER application 10120540, Impact of POLST Adoption and of Financial Incentives on Care Receipt and on Intensity of Care Preferences in Nursing Home Patients (3R01AG055751-03S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10120540. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*