title: Hospital Variation in Utilization of Life-Sustaining Treatments among Patients with Do Not Resuscitate Orders.
abstract: 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 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.
  
  
  
  California State Inpatient Database, year 2011.
  
  
  
  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.
  
  
  
  Hospitals vary widely in the scope of invasive or organ-supporting treatments provided to patients with DNR orders.
authors.affiliation: Department of Medicine, The Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Walkey
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA.
authors.forename: Janice
authors.initials: J
authors.lastname: Weinberg
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, MA.|Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA.
authors.forename: Renda Soylemez
authors.initials: RS
authors.lastname: Wiener
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Cooke
authors.affiliation: Division of General Internal Medicine, Center for Quality of Care Research, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000453:epidemiology*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008020:Life Support Care / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data; D057240:Patient Preference / Q000706:statistics & numerical data; D016414:Resuscitation Orders; D012189:Retrospective Studies; D014481:United States
keywords: Administrative data; end-of-life care; hierarchical regression models; hospice and palliative medicine; patient preference; quality assessment; risk adjustment; utilization; variation