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. 2018 Jun;53(3):1644-1661.
doi: 10.1111/1475-6773.12651. Epub 2017 Jan 18.

Hospital Variation in Utilization of Life-Sustaining Treatments among Patients with Do Not Resuscitate Orders

Allan J Walkey  1 , Janice Weinberg  2 , Renda Soylemez Wiener  3   4 , Colin R Cooke  5 , Peter K Lindenauer  6
Affiliations

Hospital Variation in Utilization of Life-Sustaining Treatments among Patients with Do Not Resuscitate Orders

Allan J Walkey et al. Health Serv Res. 2018 Jun.

Abstract

Objective: To determine between-hospital variation in interventions provided to patients with do not resuscitate (DNR) orders.

Data sources/setting: United States Agency of Healthcare Research and Quality, Healthcare Cost and Utilization Project, California State Inpatient Database.

Study design: Retrospective cohort study including hospitalized patients aged 40 and older with potential indications for invasive treatments: in-hospital cardiac arrest (indication for CPR), acute respiratory failure (mechanical ventilation), acute renal failure (hemodialysis), septic shock (central venous catheterization), and palliative care. Hierarchical logistic regression to determine associations of hospital "early" DNR rates (DNR order placed within 24 hours of admission) with utilization of invasive interventions.

Data collection/extraction methods: California State Inpatient Database, year 2011.

Principal findings: Patients with DNR orders at high-DNR-rate hospitals were less likely to receive invasive mechanical ventilation for acute respiratory failure or hemodialysis for acute renal failure, but more likely to receive palliative care than DNR patients at low-DNR-rate hospitals. Patients without DNR orders experienced similar rates of invasive interventions regardless of hospital DNR rates.

Conclusions: Hospitals vary widely in the scope of invasive or organ-supporting treatments provided to patients with DNR orders.

Keywords: Administrative data; end-of-life care; hierarchical regression models; hospice and palliative medicine; patient preference; quality assessment; risk adjustment; utilization; variation.

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Figures

Figure 1
Figure 1
Association of Hospital Ratio of Utilization between Patients with and without DNR Orders to Hospital DNR Rate for (a) Mechanical Ventilation and (b) Central Venous Catheters
See this image and copyright information in PMC

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