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The timing of do-not-resuscitate orders and hospital costs

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Abstract

The relation between the timing of do-not-resuscitate (DNR) orders and the cost of medical care is not well understood. This prospective observational study compares hospital costs and length of stay of 265 terminally ill patients with admission DNR orders, delayed DNR orders (occurring after 24 hours), or no DNR orders (full code). Patients whose orders remained full code throughout a hospital stay had similar lengths of stay, total hospital costs, and daily costs as patients with admission DNR orders. Patients with delayed DNR orders, by contrast, had a greater mortality, longer length of stay, and higher total costs than full code or admission DNR patients, but similar daily costs. The causes of delay in DNR orders and the associated higher costs are a matter for future research.

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References

  1. SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients. JAMA. 1995;274:1591–8.

    Article  Google Scholar 

  2. Teno J, Lynn J, Connors AF, et al. The illusion of end-of-life resource savings with advance directives. SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatment. J Am Geriatr Soc. 1997;45(4):513–8.

    Article  CAS  PubMed  Google Scholar 

  3. Weeks WB, Kofoed LL, Wallace AE, Welch HG. Advance directives and the cost of terminal hospitalization. Arch Intern Med. 1994;154:2077–83.

    Article  CAS  PubMed  Google Scholar 

  4. Maksoud A, Jahnigen DW, Skibinski CI. Do-not-resuscitate orders and the cost of death. Arch Intern Med. 1993;153:1249–53.

    Article  CAS  PubMed  Google Scholar 

  5. Lubitz JD, Riley GF. Trends in Medicare payments in the last year of life. N Engl J Med. 1993;328(15):1092–6.

    Article  CAS  PubMed  Google Scholar 

  6. Emanuel EJ. Cost savings at the end of life: what do the data show? JAMA. 1996;275(24):1907–14.

    Article  CAS  PubMed  Google Scholar 

  7. Detsky AS, Stricker SC, Mulley AG, Thibault GE. Prognosis, survival, and the expenditure of hospital resources for patients in an intensive care unit. N Engl J Med. 1981;5:67–72.

    Google Scholar 

  8. Emanuel EJ, Emanuel LL. The economics of dying—the illusion of cost savings at the end of life. N Engl J Med. 1994;330:540–4.

    Article  CAS  PubMed  Google Scholar 

  9. Finucane TE, Murphy DJ. New do-not-resuscitate policies—a first step in cost control. Arch Intern Med. 1993;153:1641–8.

    Article  PubMed  Google Scholar 

  10. Kanoti GA, Gombeski WR, Gulledge DA, Konrad D, Collins R, Medendorp SV. The effect of do-not-resuscitate orders on length-of-stay. Cleve Clin J Med. 1992;59:591–4.

    Article  CAS  PubMed  Google Scholar 

  11. Rossing TH, Rossing RG. Survival in lung cancer. Am Rev Respir Dis. 1992;126:771–7.

    Google Scholar 

  12. Van Dijk PI, Dippel DW, Habbema JD. Survival of patients with dementia. J Am Geriatr Soc. 1991;39:603–10.

    Article  PubMed  Google Scholar 

  13. Lundgren JD, Phillips AN, Pederson C, et al. Comparison of long-term prognosis of patients with AIDS treated and not treated with zidovudine. JAMA. 1994;271:1088–92.

    Article  CAS  PubMed  Google Scholar 

  14. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993;88:107–15.

    Article  CAS  PubMed  Google Scholar 

  15. Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100:1619–36.

    Article  CAS  PubMed  Google Scholar 

  16. Health Care Financing Administration. Revisions to payment policies and adjustments to the relative value units under the physician fee schedule for calendar year 1995; Final rule. Fed Reg. December 2, 1995.

  17. Civetta JM. The inverse relationship between cost and survival. J Surg Res. 1973;14:265–9.

    Article  CAS  PubMed  Google Scholar 

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The study was supported by National Research Service Award (NRSA) 1-F32-HS00075-01 to Dr. De Jonge from the Agency for Health Care Policy and Research (AHCPR) and by the Department of Medicine, Georgetown University School of Medicine.

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De Jonge, K.E., Sulmasy, D.P., Gold, K.G. et al. The timing of do-not-resuscitate orders and hospital costs. J GEN INTERN MED 14, 190–192 (1999). https://doi.org/10.1046/j.1525-1497.1999.00312.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1999.00312.x

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