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Text
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<a href="http://doi.org/10.1001/archinte.1995.00430190049007" target="_blank" rel="noreferrer">http://doi.org/10.1001/archinte.1995.00430190049007</a>
<a href="http://dx.doi.org/10.1001/archinte.1995.00430190049007" target="_blank" rel="noreferrer">http://dx.doi.org/10.1001/archinte.1995.00430190049007</a>
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Title
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Outcomes of patients with do-not-resuscitate orders: Toward an understanding of what do-not-resuscitate orders mean and how they affect patients
Publisher
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Archives Of Internal Medicine
Date
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1995
Subject
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DNAR Outcomes
Creator
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Wenger NS; Pearson ML; Desmond KA; Brook RH; Kahn KL
Description
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Objectives: To evaluate the outcomes of hospitalized patients with do-not-resuscitate (DNR) orders and to identify variables that may elucidate the high mortality of patients with DNR orders.Methods: Among a nationally representative sample of Medicare patients hospitalized with congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, or hip fracture, we retrospectively studied in-hospital and 180-day mortality and hospital lengths of stay for patients without DNR orders, with early (day 1 or 2) DNR orders, and with late (day 3 or later) DNR orders, before and after adjustment for sickness at hospital admission and patient and hospital characteristics.Results: In-hospital mortality for patients with DNR orders exceeded that for patients without DNR orders before adjustment (59% vs 8%, P<.001), and after accounting for differences in sickness at admission and patient and hospital characteristics (40% vs 9%, P<.001). Sicker patients were assigned earlier DNR orders. Yet, patients with early DNR orders had a lower adjusted in-hospital mortality (31% vs 49%, P<.001) and shorter hospital stay (10 vs 18 days, P<.001) than did patients with late DNR orders.Conclusions: Hospitalized older patients with DNR orders have a much higher mortality than predicted by admission demographic and clinical characteristics. The differential association of early and late DNR orders with mortality indicates that DNR orders represent a heterogeneous group of interventions that may be a marker of unmeasured sickness and a determinant of quality of care. A better understanding of what the DNR order represents and its effect on patient care is needed to ensure optimal use.(Arch Intern Med. 1995;155:2063-2068)
1995-10
Identifier
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<a href="http://doi.org/10.1001/archinte.1995.00430190049007" target="_blank" rel="noreferrer">10.1001/archinte.1995.00430190049007</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
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Journal Article
1995
Archives Of Internal Medicine
Backlog
Brook RH
Desmond KA
DNAR Outcomes
Journal Article
Kahn KL
Pearson ML
Wenger NS
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
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<a href="http://www.jstor.org.ezproxy.library.ubc.ca/stable/3766574" target="_blank" rel="noreferrer">http://www.jstor.org.ezproxy.library.ubc.ca/stable/3766574</a>
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Changes over Time in the Use of Do Not Resuscitate Orders and the Outcomes of Patients Receiving Them
Publisher
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Medical Care
Date
A point or period of time associated with an event in the lifecycle of the resource
1997
Subject
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DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Wenger NS; Pearson ML; Desmond KA; Kahn KL
Description
An account of the resource
Objectives. Do not resuscitate (DNR) orders are increasingly common, though there has been little evaluation of their changing use. The authors contrasted the use and outcomes of DNR orders for nationally representative samples of Medicare patients hospitalized with specific diagnoses in 1981 to 1982 and 1985 to 1986. Methods. Using ordinary least squares regression to adjust for patient and hospital characteristics, the authors compared use, timing and predictors of DNR orders, and survival to hospital discharge of patients with DNR orders between the two time periods. Results. After adjustment for sickness at admission and for patient and hospital factors, more patients received DNR orders in 1985 to 1986 than in 1981 to 1982 (13% versus 10%, P <0.001), with most of the increase among patients with the greatest sickness at admission. Disparity in DNR order use by age, diagnosis, functional status, preadmission residence, and gender found in 1981 to 1982 was still present in 1985 to 1986. DNR orders were written earlier in hospitalization during the latter time period. Patients with DNR orders were more likely to survive to hospital discharge in 1985 to 1986 than in 1981 to 1982 (44% versus 36%, P = 0.001), but their 30-day survival did not differ. Conclusions. Although use increased, disparities in DNR order assignment persisted in these 1980s data. Examination is needed into whether these differences persist and whether they reflect patient preferences. Systems should be developed to preserve and review the preferences of the increasing number of patients discharged after in-hospital DNR orders.
1997-04
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
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Journal Article
1997
Backlog
Desmond KA
DNAR Outcomes
Journal Article
Kahn KL
Medical Care
Pearson ML
Wenger NS