State variation in nursing home mortality outcomes according to do-not-resuscitate status.
BACKGROUND
This study compares mortality outcomes of Medicaid-reimbursed nursing home residents with and without do-not-resuscitate (DNR) orders in two diverse states.


METHODS
We used 1994 Minimum Data Set Plus (MDS+) information on 3215 nursing home residents from two states. We used Kaplan-Meier analyses to examine unadjusted mortality among those with and without DNR orders across states. We used a proportional hazard regression with main and interaction variables to model the likelihood of survival in the nursing home.


RESULTS
Approximately 27% of nursing home residents with DNR orders in State A die within the year, and approximately 40% of nursing home residents with DNR orders in State B die within the year. Regression results indicate that neither having a DNR order nor state of residence were independently associated with mortality. However, residing in State B and having a DNR order was associated with an increased risk of mortality compared with all others in the sample (risk ratio = 1.73; 95% confidence interval = 1.09, 2.75).


CONCLUSIONS
This study demonstrates that DNR orders are associated with varying mortality across states. Future research is needed to identify the reasons why state level differences exist.
Egleston
B L
BL
Department of Medicine, The University of Chicago, Illinois 60637, USA. beglesto@medicine.bsd.uchicago.edu
Rudberg
M A
MA
Brody
J A
JA
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012044:Regression Analysis; D016414:Resuscitation Orders; D014481:United States / Q000453:epidemiology