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

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.