Date of Award


Document Type


Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Douglas Sloan

Third Advisor

Godwin Odia


This report reviews the improvement in accessibility of POLST in United States hospitals since the implementation of the HITECH Act in 2009. An analysis and compilation of available information was conducted from all US acute care hospitals responding to the Information Technology Supplement to the annual American Hospital Association (AHA) survey. The survey was voluntary including non-members of the association. The total number of hospitals that participated in 2009 were 2903 while 2782 in 2018. From the results, there was slight increase in hospital beds in 2019 compared to 2018. In 2009, 64% of the hospitals were private nonprofit, 25% government hospitals and 11% were private for-profit hospitals while in 2018, most were private nonprofit at 66%, government at 22% and private for profit 12%. The report showed a significant improvement (42%) in the hospitals capability to fully implement advanced directive (DNR) across every unit by 2018. The study shows smaller hospitals recorded much improvements in DNR by 2018 as opposed to larger hospitals. This was similar to government and For-profit hospitals unlike nonprofit hospitals that realized insignificant improvements. Besides a hospitals intent to apply for CMS payments in 2009 had no significant effect in DNR availability in 2018. It was found that HITECH has greatly enhanced the availability of POLST information especially for emergency situations.


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