Improving Physician Orders for Life-Sustaining Treatment (POLST) Documentation Through an Age-Friendly Health Systems 4Ms What Matters Workflow in an Outpatient Geriatric Clinic
- 1Geriatrics/Internal Medicine, Eisenhower Medical Center, Rancho Mirage, USA
- 2Geriatrics, Eisenhower Medical Center, Rancho Mirage, USA
Abstract
Background: Physician Orders for Life-Sustaining Treatment (POLST) translate treatment preferences into portable medical orders for people with serious illness or advanced frailty. We evaluated POLST documentation after integrating an advance care planning prompt into an Age-Friendly Health Systems 4Ms What Matters workflow in an outpatient geriatric clinic.
Methods: This single-center quality improvement project compared aggregate provider data for 2024 and 2025 in a clinic serving approximately 2,000 adults aged 65 years or older. Beginning in January 2025, a standardized electronic health record template incorporated the 4Ms and POLST prompts. Implementation included individual provider training, staff instructions, and quarterly one-to-one provider feedback on all 4Ms measures with encouragement to use the templates. Reported POLST documentation proportions used counts of encounters associated with scanned forms and total encounter denominators. Analyses were descriptive; monthly Provider C percentages were plotted without statistical process control limits.
Results: Overall documentation increased from 11.7% (335/2,865) to 26.9% (1,158/4,305), an increase of 15.2 percentage points and approximately 130% relative to baseline. Provider-level proportions increased from 4.8% to 15.9% for Provider A, 7.3% to 10.1% for Provider B, and 21.7% to 61.9% for Provider C. Provider C reached at least 84.5% in each of the final four months of 2025. The investigator's account of his own workflow identified in-visit discussion and form completion as practices warranting further study.
Conclusions: An Age-Friendly Health Systems 4Ms What Matters workflow was associated with increased reported encounter-level POLST documentation, with substantial variation among clinicians. The findings support further testing of conversation training and workflow support. This uncontrolled encounter-level evaluation does not establish causality, new form completion, or goal-concordant care.
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BibTeX
@article{moshiri2026improving,
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}},
author = {Kourosh A Moshiri and Louis Guitron and Hyo Mun},
journal = {Cureus},
year = {2026},
month = nov,
doi = {10.7759/cureus.119085},
url = {https://doi.org/10.7759/cureus.119085},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Improving Physician Orders for Life-Sustaining Treatment (POLST) Documentation Through an Age-Friendly Health Systems 4Ms What Matters Workflow in an Outpatient Geriatric Clinic
AU - Kourosh A Moshiri
AU - Louis Guitron
AU - Hyo Mun
PY - 2026
DA - 2026/11/03
JO - Cureus
DO - 10.7759/cureus.119085
UR - https://doi.org/10.7759/cureus.119085
AB - Background: Physician Orders for Life-Sustaining Treatment (POLST) translate treatment preferences into portable medical orders for people with serious illness or advanced frailty. We evaluated POLST documentation after integrating an advance care planning prompt into an Age-Friendly Health Systems 4Ms What Matters workflow in an outpatient geriatric clinic. Methods: This single-center quality improvement project compared aggregate provider data for 2024 and 2025 in a clinic serving approximately 2,000 adults aged 65 years or older. Beginning in January 2025, a standardized electronic health record template incorporated the 4Ms and POLST prompts. Implementation included individual provider training, staff instructions, and quarterly one-to-one provider feedback on all 4Ms measures with encouragement to use the templates. Reported POLST documentation proportions used counts of encounters associated with scanned forms and total encounter denominators. Analyses were descriptive; monthly Provider C percentages were plotted without statistical process control limits. Results: Overall documentation increased from 11.7% (335/2,865) to 26.9% (1,158/4,305), an increase of 15.2 percentage points and approximately 130% relative to baseline. Provider-level proportions increased from 4.8% to 15.9% for Provider A, 7.3% to 10.1% for Provider B, and 21.7% to 61.9% for Provider C. Provider C reached at least 84.5% in each of the final four months of 2025. The investigator's account of his own workflow identified in-visit discussion and form completion as practices warranting further study. Conclusions: An Age-Friendly Health Systems 4Ms What Matters workflow was associated with increased reported encounter-level POLST documentation, with substantial variation among clinicians. The findings support further testing of conversation training and workflow support. This uncontrolled encounter-level evaluation does not establish causality, new form completion, or goal-concordant care.
SN - 2168-8184
ER -