Hospital characteristics play a role in use of do-not-resuscitate orders

August 08, 2005

CHICAGO - Hospital characteristics, including size, non-profit status and affiliation with a university, appear to be associated with use of do-not-resuscitate orders (DNR) in California, independent of the patient's characteristics, according to a study in the August 8/22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Do-not-resuscitate orders are essential for guiding the care provided to hospitalized patients, according to background information in the article. Treatments like resuscitation may be inappropriate or may afford short-term benefits without achieving valued long-term goals. If DNR orders reflect patients' preferences and guide care that is consistent with these preferences, DNR orders can be considered indicators of the quality of health care at an institution, the authors suggest.

David S. Zingmond, M.D., Ph.D., and Neil S. Wenger, M.D., M.P.H., of The David Geffen School of Medicine at UCLA, Los Angeles, analyzed records from California hospitals to determine whether institutional factors were associated with the use of DNR orders. The researchers assessed the association between hospital characteristics, (size, profit status and academic status) and the use of a DNR order written within the first 24 hours of admission. The researchers also assessed whether there were regional differences in the use of DNR orders. Of approximately one and half million patients 50 or older admitted for acute care during 2000, the researchers included in their analysis 819,686 admissions at 386 California hospitals for 40 of the most common medical and surgical/procedural diagnoses-related groups (DRGs).

The researchers found that the percentage of DNR orders written within the first 24 hours of admission varied from two percent for patients aged 50-59 years to 17 percent for patients 80 years or older. The odds of having early DNR orders written were significantly lower in for-profit vs. private non-profit hospitals, were higher in the smallest vs. the largest hospitals, and were lower in academic vs. non-academic institutions. The rate of DNR order use varied by 10-fold depending on region with the highest rates in rural areas, the authors report.

"The initiation of end-of-life discussions and the implementation of DNR orders are important toward ensuring that patients receive care appropriate to their prognosis and preferences," the authors conclude. "Hospital characteristics appear to be associated with the use of DNR orders, even after accounting for differences in patient characteristics. This association reflects institutional culture, technological bent, and physician practice patterns."
(Arch Intern Med. 2005; 165:1705-1712. Available pre-embargo to the media at

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email

The JAMA Network Journals

Related Health Care Articles from Brightsurf:

Study evaluates new World Health Organization Labor Care Guide for maternity care providers
The World Health Organization developed the new Labor Care Guide to support clinicians in providing good quality, women-centered care during labor and childbirth.

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.

International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.

The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .

Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.

High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.

Read More: Health Care News and Health Care Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to