Outcomes of Patients with Do-Not-Resuscitate Orders

Toward an Understanding of What Do-Not-Resuscitate Orders Mean and How They Affect Patients

Published In: Archives of Internal Medicine, v. 155, no. 19, Oct. 23, 1995, p. 2063-2068

Posted on RAND.org on December 31, 1994

by Neil S. Wenger, Marjorie L. Pearson, Katherine Desmond, Robert H. Brook, Katherine L. Kahn

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The subjects of this study were part of the DRG Quality of Care Study, which included a national sample of hospitalized Medicare patients. The authors found that hospitalized older patients with do-not-resuscitate (DNR) orders had a much higher mortality rate than predicted by demographic and clinical characteristics at admission. Inhospital mortality was 59 percent for patients with DNR orders, compared with 8 percent for those without such orders, and the difference remained substantial even after accounting for variations in clinical sickness at admission and patient and hospital characteristics. The DNR orders assigned early in the hospital stay were different from those assigned later. They were associated with lower mortality and shorter hospital stay. These differences suggest that DNR orders are heterogeneous; some may be markers of unmeasured sickness, others may be markers of determinants 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.

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