Dong W Chang1, Eric P Brass. 1. Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomed Research Institute, Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA, dchang@labiomed.org.
Abstract
BACKGROUND: Identifying factors associated with do-not-resuscitate (DNR) orders is an informative step in developing strategies to improve their use. As such, a descriptive analysis of the factors associated with the use of DNR orders in the early and late phases of hospitalizations for sepsis was performed. METHODS: A retrospective cohort of adult patients hospitalized for sepsis was identified using a statewide administrative database. DNR orders placed within 24 h of hospitalization (early DNR) and after 24 h of hospitalization (late DNR) were the primary outcome variables. Multivariable logistic regression analysis was used to identify patient, hospital, and healthcare system-related factors associated with the use of early and late DNR orders. RESULTS: Among 77,329 patients hospitalized for sepsis, 27.5 % had a DNR order during their hospitalization. Among the cases with a DNR order, 75.5 % had the order within 24 h of hospitalization. Smaller hospital size and the absence of a teaching program increased the likelihood of an early DNR order being written. Additionally, greater patient age, female gender, White race, more medical comorbidities, Medicare payer status and admission from a skilled nursing facility were all significantly associated with the likelihood of having an early DNR. The strength of association between these factors and the use of late DNR orders was weaker. In contrast, the greater the burden of medical comorbidities, the more likely a patient was to receive a late DNR order. CONCLUSION: Multiple patient, hospital, and healthcare system-related factors are associated with the use of DNR orders in sepsis, many of which appear to be independent of a patient's clinical status. Over the course of the hospitalization, the burden of medical illness shows a stronger association relative to other variables. The influence of these multi-level factors needs to be recognized in strategies to improve the use of DNR orders. .
BACKGROUND: Identifying factors associated with do-not-resuscitate (DNR) orders is an informative step in developing strategies to improve their use. As such, a descriptive analysis of the factors associated with the use of DNR orders in the early and late phases of hospitalizations for sepsis was performed. METHODS: A retrospective cohort of adult patients hospitalized for sepsis was identified using a statewide administrative database. DNR orders placed within 24 h of hospitalization (early DNR) and after 24 h of hospitalization (late DNR) were the primary outcome variables. Multivariable logistic regression analysis was used to identify patient, hospital, and healthcare system-related factors associated with the use of early and late DNR orders. RESULTS: Among 77,329 patients hospitalized for sepsis, 27.5 % had a DNR order during their hospitalization. Among the cases with a DNR order, 75.5 % had the order within 24 h of hospitalization. Smaller hospital size and the absence of a teaching program increased the likelihood of an early DNR order being written. Additionally, greater patient age, female gender, White race, more medical comorbidities, Medicare payer status and admission from a skilled nursing facility were all significantly associated with the likelihood of having an early DNR. The strength of association between these factors and the use of late DNR orders was weaker. In contrast, the greater the burden of medical comorbidities, the more likely a patient was to receive a late DNR order. CONCLUSION: Multiple patient, hospital, and healthcare system-related factors are associated with the use of DNR orders in sepsis, many of which appear to be independent of a patient's clinical status. Over the course of the hospitalization, the burden of medical illness shows a stronger association relative to other variables. The influence of these multi-level factors needs to be recognized in strategies to improve the use of DNR orders. .
Authors: Amber E Barnato; Zekarias Berhane; Lisa A Weissfeld; Chung-Chou H Chang; Walter T Linde-Zwirble; Derek C Angus Journal: Health Serv Res Date: 2006-12 Impact factor: 3.402
Authors: R B Hakim; J M Teno; F E Harrell; W A Knaus; N Wenger; R S Phillips; P Layde; R Califf; A F Connors; J Lynn Journal: Ann Intern Med Date: 1996-08-15 Impact factor: 25.391
Authors: Amber E Barnato; Sherri L Alexander; Walter T Linde-Zwirble; Derek C Angus Journal: Am J Respir Crit Care Med Date: 2007-11-01 Impact factor: 21.405
Authors: Allan J Walkey; Janice Weinberg; Renda Soylemez Wiener; Colin R Cooke; Peter K Lindenauer Journal: JAMA Intern Med Date: 2016-01 Impact factor: 21.873
Authors: Purav Mody; Ambarish Pandey; Arthur S Slutsky; Matthew W Segar; Alex Kiss; Paul Dorian; Janet Parsons; Damon C Scales; Valeria E Rac; Sheldon Cheskes; Arlene S Bierman; Beth L Abramson; Sara Gray; Rob A Fowler; Katie N Dainty; Ahamed H Idris; Laurie Morrison Journal: Circulation Date: 2020-12-15 Impact factor: 29.690
Authors: Daniel J Ouyang; Lindsay Lief; David Russell; Jiehui Xu; David A Berlin; Eliza Gentzler; Amanda Su; Zara R Cooper; Steven S Senglaub; Paul K Maciejewski; Holly G Prigerson Journal: PLoS One Date: 2020-02-18 Impact factor: 3.240
Authors: Sarah M Perman; Brenda L Beaty; Stacie L Daugherty; Edward P Havranek; Jason S Haukoos; Elizabeth Juarez-Colunga; Steven M Bradley; Timothy J Fendler; Paul S Chan Journal: J Am Heart Assoc Date: 2020-02-17 Impact factor: 5.501