Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep;14(9):1485-1489.
doi: 10.1513/AnnalsATS.201704-303RL.

Hospital Variation in Do-Not-Resuscitate Orders and End-of-Life Healthcare Use in the United States

Allan J Walkey  1 , Amber E Barnato  2   3 , Seppo T Rinne  4 , Colin R Cooke  5 , Meng-Shiou Shieh  6   7 , Penelope S Pekow  6   7 , Peter K Lindenauer  6   7
Affiliations

Hospital Variation in Do-Not-Resuscitate Orders and End-of-Life Healthcare Use in the United States

Allan J Walkey et al. Ann Am Thorac Soc. 2017 Sep.
No abstract available

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Caterpillar plot showing variation in risk-standardized do-not-resuscitate (DNR) rate (%, with 95% confidence intervals) (y axis: % of patients aged 65 yr or older with a DNR order) across hospitals in the United States. Hospitals are ranked along the x axis in order of increasing DNR rates.
Figure 2.
Figure 2.
Association between hospital risk-adjusted do-not-resuscitate (DNR) rate and measures of end-of-life healthcare utilization; β estimate per 1% increase in hospital DNR rate (SE); P value. (A) Hospital care intensity index; β = −0.015 (0.002); P < 0.001. (B) Total Medicare part B spending ($) per patient in last 2 years of life; β = −144 (32); P < 0.001. (C) Intensive care beds per 1,000 decedents during last 2 years of life; β = −0.41 (0.09); P < 0.001. (D) Hospital reimbursement ($) per decedent in last 2 years of life; β = −142.1 (83.6); P < 0.001. (E) Hospital days per decedent; β = −0.20 (0.04); P < 0.001. (F) Intensive care days per decedent; β = −0.09 (0.02); P < 0.001. (G) Percent of deaths occurring in the hospital; β = −0.10 (0.05); P = 0.06. (H) Percent of deaths that included an intensive care unit (ICU) admission; β = −0.18 (0.04); P < 0.001. (I) Percent of patients seeing 10 or more different physicians; β = −0.38 (0.09); P < 0.001. (J) Number of different physicians seen per decedent; β = −0.09 (0.02); P < 0.001. (K) Percent of decedents enrolled in hospice; β = −0.10 (0.05); P = 0.26. (L) Hospice days per decedent; β = −0.05 (0.05); P = 0.29.
Figure 2.
Figure 2.
Association between hospital risk-adjusted do-not-resuscitate (DNR) rate and measures of end-of-life healthcare utilization; β estimate per 1% increase in hospital DNR rate (SE); P value. (A) Hospital care intensity index; β = −0.015 (0.002); P < 0.001. (B) Total Medicare part B spending ($) per patient in last 2 years of life; β = −144 (32); P < 0.001. (C) Intensive care beds per 1,000 decedents during last 2 years of life; β = −0.41 (0.09); P < 0.001. (D) Hospital reimbursement ($) per decedent in last 2 years of life; β = −142.1 (83.6); P < 0.001. (E) Hospital days per decedent; β = −0.20 (0.04); P < 0.001. (F) Intensive care days per decedent; β = −0.09 (0.02); P < 0.001. (G) Percent of deaths occurring in the hospital; β = −0.10 (0.05); P = 0.06. (H) Percent of deaths that included an intensive care unit (ICU) admission; β = −0.18 (0.04); P < 0.001. (I) Percent of patients seeing 10 or more different physicians; β = −0.38 (0.09); P < 0.001. (J) Number of different physicians seen per decedent; β = −0.09 (0.02); P < 0.001. (K) Percent of decedents enrolled in hospice; β = −0.10 (0.05); P = 0.26. (L) Hospice days per decedent; β = −0.05 (0.05); P = 0.29.
See this image and copyright information in PMC

References

    1. Goodman DG, Esty AR, Fischer ES, Chang C.Trends and variation in end-of-life care for Medicare beneficiaries with severe chronic illness.Hanover, NH: The Dartmouth Institute for Health Policy and Clinical Practice Center for Health Policy Research. 2011 - PubMed
    1. Bischoff KE, Sudore R, Miao Y, Boscardin WJ, Smith AK. Advance care planning and the quality of end-of-life care in older adults. J Am Geriatr Soc. 2013;61:209–214. - PMC - PubMed
    1. Medicode (Firm) ICD-9-CM: International classification of diseases, 9th revision, clinical modification. 1996. Salt Lake City, UT: Medicode.
    1. HCUP National/Nationwide Inpatient Sample (NIS) Healthcare Cost and Utilization Project (HCUP). 2012. Rockville, MD: Agency for Healthcare Research and Quality.
    1. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27. - PubMed

LinkOut - more resources