{"id":"https://openalex.org/W7225225151","doi":"https://doi.org/10.7759/cureus.119085","title":"Improving Physician Orders for Life-Sustaining Treatment (POLST) Documentation Through an Age-Friendly Health Systems 4Ms What Matters Workflow in an Outpatient Geriatric Clinic","display_name":"Improving Physician Orders for Life-Sustaining Treatment (POLST) Documentation Through an Age-Friendly Health Systems 4Ms What Matters Workflow in an Outpatient Geriatric Clinic","publication_year":2026,"publication_date":"2026-11-03","ids":{"openalex":"https://openalex.org/W7225225151","doi":"https://doi.org/10.7759/cureus.119085","pmid":"https://pubmed.ncbi.nlm.nih.gov/42985187","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13731812"},"language":"en","primary_location":{"id":"doi:10.7759/cureus.119085","doi":"https://doi.org/10.7759/cureus.119085","is_oa":true,"landing_page_url":"https://doi.org/10.7759/cureus.119085","pdf_url":"https://www.cureus.com/articles/548324-improving-physician-orders-for-life-sustaining-treatment-polst-documentation-through-an-age-friendly-health-systems-4ms-what-matters-workflow-in-an-outpatient-geriatric-clinic.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://www.cureus.com/articles/548324-improving-physician-orders-for-life-sustaining-treatment-polst-documentation-through-an-age-friendly-health-systems-4ms-what-matters-workflow-in-an-outpatient-geriatric-clinic.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5151895557","display_name":"Kourosh A Moshiri","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1327543694","display_name":"Eisenhower Medical Center","ror":"https://ror.org/050wjeh45","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1327543694"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Kourosh A Moshiri","raw_affiliation_strings":["Geriatrics/Internal Medicine, Eisenhower Medical Center, Rancho Mirage, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Geriatrics/Internal Medicine, Eisenhower Medical Center, Rancho Mirage, USA","institution_ids":["https://openalex.org/I1327543694"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160682617","display_name":"Louis Guitron","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1327543694","display_name":"Eisenhower Medical Center","ror":"https://ror.org/050wjeh45","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1327543694"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Louis Guitron","raw_affiliation_strings":["Geriatrics, Eisenhower Medical Center, Rancho Mirage, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Geriatrics, Eisenhower Medical Center, Rancho Mirage, USA","institution_ids":["https://openalex.org/I1327543694"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5160630198","display_name":"Hyo Mun","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1327543694","display_name":"Eisenhower Medical Center","ror":"https://ror.org/050wjeh45","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1327543694"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Hyo Mun","raw_affiliation_strings":["Geriatrics/Internal Medicine, Eisenhower Medical Center, Rancho Mirage, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Geriatrics/Internal Medicine, Eisenhower Medical Center, Rancho Mirage, USA","institution_ids":["https://openalex.org/I1327543694"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5151895557"],"corresponding_institution_ids":["https://openalex.org/I1327543694"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.87345616,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"18","issue":"11","first_page":"e119085","last_page":"e119085"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10177","display_name":"Palliative Care and End-of-Life Issues","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10177","display_name":"Palliative Care and End-of-Life Issues","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10350","display_name":"Electronic Health Records Systems","score":0.00039999998989515007,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13147","display_name":"Ethics and bioethics in healthcare","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/physician-orders-for-life-sustaining-treatment","display_name":"POLST","score":0.9470000267028809},{"id":"https://openalex.org/keywords/advance-care-planning","display_name":"advance care planning","score":0.7749999761581421},{"id":"https://openalex.org/keywords/age-friendly-health-systems","display_name":"age-friendly health systems","score":0.8510000109672546},{"id":"https://openalex.org/keywords/geriatric-outpatient-clinic","display_name":"geriatric outpatient clinic","score":0.8159999847412109},{"id":"https://openalex.org/keywords/older-adults","display_name":"older adults","score":0.7549999952316284},{"id":"https://openalex.org/keywords/electronic-health-record-prompts","display_name":"electronic health record prompts","score":0.8019999861717224},{"id":"https://openalex.org/keywords/provider-feedback","display_name":"provider feedback","score":0.5049999952316284},{"id":"https://openalex.org/keywords/goal-concordant-care","display_name":"goal-concordant care","score":0.7070000171661377},{"id":"https://openalex.org/keywords/serious-illness","display_name":"serious illness","score":0.4429999887943268},{"id":"https://openalex.org/keywords/frailty","display_name":"frailty","score":0.8629999756813049}],"concepts":[{"id":"https://openalex.org/C177212765","wikidata":"https://www.wikidata.org/wiki/Q627335","display_name":"Workflow","level":2,"score":0.8580999970436096},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8324000239372253},{"id":"https://openalex.org/C56666940","wikidata":"https://www.wikidata.org/wiki/Q788790","display_name":"Documentation","level":2,"score":0.8145999908447266},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.49540001153945923},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.46209999918937683},{"id":"https://openalex.org/C195910791","wikidata":"https://www.wikidata.org/wiki/Q1324077","display_name":"Medical record","level":2,"score":0.4514999985694885},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.4496000111103058},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.43860000371932983},{"id":"https://openalex.org/C3020110884","wikidata":"https://www.wikidata.org/wiki/Q695416","display_name":"Outpatient clinic","level":2,"score":0.3935999870300293},{"id":"https://openalex.org/C71405471","wikidata":"https://www.wikidata.org/wiki/Q757012","display_name":"Quality management","level":3,"score":0.3926999866962433},{"id":"https://openalex.org/C3020144179","wikidata":"https://www.wikidata.org/wiki/Q10871684","display_name":"Electronic health record","level":3,"score":0.3833000063896179},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.3668999969959259},{"id":"https://openalex.org/C2777995714","wikidata":"https://www.wikidata.org/wiki/Q18209059","display_name":"Advance care planning","level":3,"score":0.3580000102519989},{"id":"https://openalex.org/C2779530757","wikidata":"https://www.wikidata.org/wiki/Q1207505","display_name":"Quality (philosophy)","level":2,"score":0.3513999879360199},{"id":"https://openalex.org/C2777200299","wikidata":"https://www.wikidata.org/wiki/Q52943","display_name":"Conversation","level":2,"score":0.3398999869823456},{"id":"https://openalex.org/C145642194","wikidata":"https://www.wikidata.org/wiki/Q870895","display_name":"Health informatics","level":3,"score":0.3176000118255615},{"id":"https://openalex.org/C124306116","wikidata":"https://www.wikidata.org/wiki/Q2512965","display_name":"Ambulatory care","level":3,"score":0.30970001220703125},{"id":"https://openalex.org/C39896193","wikidata":"https://www.wikidata.org/wiki/Q380344","display_name":"Descriptive statistics","level":2,"score":0.2985000014305115},{"id":"https://openalex.org/C3018060332","wikidata":"https://www.wikidata.org/wiki/Q10871684","display_name":"Electronic medical record","level":2,"score":0.29510000348091125},{"id":"https://openalex.org/C2776354556","wikidata":"https://www.wikidata.org/wiki/Q10910281","display_name":"Health information technology","level":3,"score":0.28760001063346863},{"id":"https://openalex.org/C2988170871","wikidata":"https://www.wikidata.org/wiki/Q11000047","display_name":"Healthcare system","level":3,"score":0.2827000021934509},{"id":"https://openalex.org/C2989236134","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Patient care","level":2,"score":0.28040000796318054},{"id":"https://openalex.org/C133462117","wikidata":"https://www.wikidata.org/wiki/Q4929239","display_name":"Data collection","level":2,"score":0.265500009059906},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.25949999690055847}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.7759/cureus.119085","doi":"https://doi.org/10.7759/cureus.119085","is_oa":true,"landing_page_url":"https://doi.org/10.7759/cureus.119085","pdf_url":"https://www.cureus.com/articles/548324-improving-physician-orders-for-life-sustaining-treatment-polst-documentation-through-an-age-friendly-health-systems-4ms-what-matters-workflow-in-an-outpatient-geriatric-clinic.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13731812","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13731812/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13731812/pdf/cureus-0018-00000119085.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"Text"},{"id":"pmid:42985187","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42985187","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.7759/cureus.119085","doi":"https://doi.org/10.7759/cureus.119085","is_oa":true,"landing_page_url":"https://doi.org/10.7759/cureus.119085","pdf_url":"https://www.cureus.com/articles/548324-improving-physician-orders-for-life-sustaining-treatment-polst-documentation-through-an-age-friendly-health-systems-4ms-what-matters-workflow-in-an-outpatient-geriatric-clinic.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9907000064849854,"display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225225151.pdf","grobid_xml":"https://content.openalex.org/works/W7225225151.grobid-xml"},"referenced_works_count":11,"referenced_works":["https://openalex.org/W2097554271","https://openalex.org/W2262671496","https://openalex.org/W3006061322","https://openalex.org/W3120416406","https://openalex.org/W3201243967","https://openalex.org/W4308369809","https://openalex.org/W4390062062","https://openalex.org/W4391998854","https://openalex.org/W4399261111","https://openalex.org/W4405366382","https://openalex.org/W4409525581"],"related_works":["https://openalex.org/W7155668998","https://openalex.org/W4280501625","https://openalex.org/W7223611704","https://openalex.org/W4387142906","https://openalex.org/W2803445567","https://openalex.org/W7213575396","https://openalex.org/W2736405002","https://openalex.org/W7118079833","https://openalex.org/W2314683684","https://openalex.org/W2095240855"],"abstract_inverted_index":{"BACKGROUND:":[0],"Physician":[1],"Orders":[2],"for":[3,14,57,170,176,183],"Life-Sustaining":[4],"Treatment":[5],"(POLST)":[6],"translate":[7],"treatment":[8],"preferences":[9],"into":[10,33],"portable":[11],"medical":[12],"orders":[13],"people":[15],"with":[16,105,120,230,236],"serious":[17],"illness":[18],"or":[19,71,263],"advanced":[20],"frailty.":[21],"We":[22],"evaluated":[23],"POLST":[24,87,112,234],"documentation":[25,113,143],"after":[26],"integrating":[27],"an":[28,34,43,151],"advance":[29],"care":[30],"planning":[31],"prompt":[32],"Age-Friendly":[35,221],"Health":[36,222],"Systems":[37,223],"4Ms":[38,85,103,224],"What":[39,225],"Matters":[40,226],"workflow":[41,207,227,250],"in":[42,61,74,192],"outpatient":[44],"geriatric":[45],"clinic.":[46],"METHODS:":[47],"This":[48,252],"single-center":[49],"quality":[50],"improvement":[51],"project":[52],"compared":[53],"aggregate":[54],"provider":[55,92,99],"data":[56],"2024":[58],"and":[59,86,96,123,157,179,211,249],"2025":[60],"a":[62,77],"clinic":[63],"serving":[64],"approximately":[65,158],"2,000":[66],"adults":[67],"aged":[68],"65":[69],"years":[70],"older.":[72],"Beginning":[73],"January":[75],"2025,":[76],"standardized":[78],"electronic":[79],"health":[80],"record":[81],"template":[82],"incorporated":[83],"the":[84,109,195],"prompts.":[88],"Implementation":[89],"included":[90],"individual":[91],"training,":[93],"staff":[94],"instructions,":[95],"quarterly":[97],"one-to-one":[98],"feedback":[100],"on":[101],"all":[102],"measures":[104],"encouragement":[106],"to":[107,148,161,168,174,181],"use":[108],"templates.":[110],"Reported":[111],"proportions":[114,164],"used":[115],"counts":[116],"of":[117,153,194,199,204,246],"encounters":[118],"associated":[119,229],"scanned":[121],"forms":[122],"total":[124],"encounter":[125],"denominators.":[126],"Analyses":[127],"were":[128,134],"descriptive;":[129],"monthly":[130],"Provider":[131,171,177,184,186],"C":[132,187],"percentages":[133],"plotted":[135],"without":[136],"statistical":[137],"process":[138],"control":[139],"limits.":[140],"RESULTS:":[141],"Overall":[142],"increased":[144,165,231],"from":[145,166],"11.7%":[146],"(335/2,865)":[147],"26.9%":[149],"(1,158/4,305),":[150],"increase":[152],"15.2":[154],"percentage":[155],"points":[156],"130%":[159],"relative":[160],"baseline.":[162],"Provider-level":[163],"4.8%":[167],"15.9%":[169],"A,":[172],"7.3%":[173],"10.1%":[175],"B,":[178],"21.7%":[180],"61.9%":[182],"C.":[185],"reached":[188],"at":[189],"least":[190],"84.5%":[191],"each":[193],"final":[196],"four":[197],"months":[198],"2025.":[200],"The":[201,241],"investigator's":[202],"account":[203],"his":[205],"own":[206],"identified":[208],"in-visit":[209],"discussion":[210],"form":[212,261],"completion":[213],"as":[214],"practices":[215],"warranting":[216],"further":[217,244],"study.":[218],"CONCLUSIONS:":[219],"An":[220],"was":[228],"reported":[232],"encounter-level":[233,254],"documentation,":[235],"substantial":[237],"variation":[238],"among":[239],"clinicians.":[240],"findings":[242],"support":[243],"testing":[245],"conversation":[247],"training":[248],"support.":[251],"uncontrolled":[253],"evaluation":[255],"does":[256],"not":[257],"establish":[258],"causality,":[259],"new":[260],"completion,":[262],"goal-concordant":[264],"care.":[265]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-11-05T00:00:00"}
