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- Title
Hospital Variation in Utilization of Life-Sustaining Treatments among Patients with Do Not Resuscitate Orders.
- Authors
Walkey, Allan J.; Weinberg, Janice; Wiener, Renda Soylemez; Cooke, Colin R.; Lindenauer, Peter K.
- Abstract
<bold>Objective: </bold>To determine between-hospital variation in interventions provided to patients with do not resuscitate (DNR) orders.<bold>Data Sources/setting: </bold>United States Agency of Healthcare Research and Quality, Healthcare Cost and Utilization Project, California State Inpatient Database.<bold>Study Design: </bold>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.<bold>Data Collection/extraction Methods: </bold>California State Inpatient Database, year 2011.<bold>Principal Findings: </bold>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.<bold>Conclusions: </bold>Hospitals vary widely in the scope of invasive or organ-supporting treatments provided to patients with DNR orders.
- Subjects
UNITED States; CRITICAL care medicine; INTENSIVE care units; MEDICAL care costs; HOSPITAL admission &; discharge; MEDICAL care; HOSPITAL statistics; CATASTROPHIC illness; DO-not-resuscitate orders; INSURANCE; LIFE support systems in critical care; PALLIATIVE treatment; PATIENT satisfaction; RESEARCH funding; RETROSPECTIVE studies
- Publication
Health Services Research, 2018, Vol 53, Issue 3, p1644
- ISSN
0017-9124
- Publication type
journal article
- DOI
10.1111/1475-6773.12651