title: Accuracy of do not resuscitate (DNR) in administrative data.
abstract: This article evaluates the accuracy of reporting do not resuscitate (DNR) orders in administrative data for use in risk-adjusted hospital assessments. We compared DNR reporting by 48 California hospitals in 2005 patient discharge data (PDD) with gold-standard assessments made by registered nurses (RNs) who reabstracted 1,673 records of patients with myocardial infarction, pneumonia, or heart failure. The PDD agreed with the RN reabstraction in 1,411 (84.3%) cases. The administrative data did not reflect a DNR order in 71 of 512 records where the RN indicated there was (14% false negative rates), and reflected a DNR order in 191 of 1,161 records where the RN indicated there was not (16% false positive rate). The accuracy of DNR was more problematic for patients who died, suggesting that hospital-reported DNR is problematic for capturing patient preferences for resuscitation that can be used for risk-adjusted outcomes assessments.
authors.affiliation: University of California-San Francisco, San Francisco, CA 94110, USA. legoldman@medsfgh.ucsf.edu
authors.forename: L Elizabeth
authors.initials: LE
authors.lastname: Goldman
authors.forename: Philip W
authors.initials: PW
authors.lastname: Chu
authors.forename: Dennis
authors.initials: D
authors.lastname: Osmond
authors.forename: Andrew
authors.initials: A
authors.lastname: Bindman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006739:Hospital Administration / Q000592:standards / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D009741:Nursing Staff, Hospital; D011014:Pneumonia / Q000401:mortality; D016414:Resuscitation Orders; D020379:Risk Adjustment; D055815:Young Adult