Hospitals vary widely in the scope of invasive and organ-supportive interventions provided to patients with DNR (do not resuscitate) orders, with high-DNR-rate facilities less likely to use invasive and organ-supportive interventions and more likely to use palliative care, according to a new study led by researchers from Boston University School of Public Health (BUSPH).
The study, in the journal Health Services Research, found that patients with DNR orders “may have considerably different experiences depending upon the hospital to which they are admitted, with ramifications for the reporting of hospital practices around wishes for life-sustaining treatments, measurement of practice variation, and hospital quality.”
The research team, which analyzed claims data from California hospitals, found that hospitals with higher rates of DNR orders tended to use a “less invasive, more palliative approach” among patients with such orders — contrary to the theory that lower-DNR hospitals might tend to enforce DNR orders more strictly.
“Our findings suggest that studies should continue to explore how interactions between patient beliefs and physician practice styles drive measured variation in hospital DNR rates and the scope of therapies associated with DNR orders,” the authors said. They said that identifying and reporting the variation in DNR practices would produce greater transparency for patients, potentially allowing them to choose hospitals with practice patterns that “best align with their beliefs.”
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