August 9, 2005
Hospital Characteristics Play a Role in Use of Do-not-resuscitate Orders
CHICAGO "“ Hospital characteristics, including size, non-profit status and affiliation with a university, appear to be associated with use of do-not-resuscitate orders (DNR) in California, independent of the patient's characteristics, according to a study in the August 8/22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Do-not-resuscitate orders are essential for guiding the care provided to hospitalized patients, according to background information in the article. Treatments like resuscitation may be inappropriate or may afford short-term benefits without achieving valued long-term goals. If DNR orders reflect patients' preferences and guide care that is consistent with these preferences, DNR orders can be considered indicators of the quality of health care at an institution, the authors suggest.
The researchers found that the percentage of DNR orders written within the first 24 hours of admission varied from two percent for patients aged 50-59 years to 17 percent for patients 80 years or older. The odds of having early DNR orders written were significantly lower in for-profit vs. private non-profit hospitals, were higher in the smallest vs. the largest hospitals, and were lower in academic vs. non-academic institutions. The rate of DNR order use varied by 10-fold depending on region with the highest rates in rural areas, the authors report.
"The initiation of end-of-life discussions and the implementation of DNR orders are important toward ensuring that patients receive care appropriate to their prognosis and preferences," the authors conclude. "Hospital characteristics appear to be associated with the use of DNR orders, even after accounting for differences in patient characteristics. This association reflects institutional culture, technological bent, and physician practice patterns."
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