To determine between‐hospital variation in interventions provided to patients with do not resuscitate (DNR) orders.
United States Agency of Healthcare Research and Quality, Healthcare Cost and Utilization Project, California State Inpatient Database.
Retrospective cohort study including hospitalized patients aged 40 and older with potential indications for invasive treatments: in‐hospital cardiac arrest (indication for ), 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” rates ( order placed within 24 hours of admission) with utilization of invasive interventions.
Data Collection/Extraction Methods
California State Inpatient Database, year 2011.
Patients with orders at high‐‐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 patients at low‐‐rate hospitals. Patients without orders experienced similar rates of invasive interventions regardless of hospital rates.
Hospitals vary widely in the scope of invasive or organ‐supporting treatments provided to patients with orders.
