CHANGES OVER TIME IN THE USE OF DO NOT RESUSCITATE ORDERS AND THE OUTCOMES OF PATIENTS RECEIVING THEM

OBJECTIVES. DO not resuscitate (DNR) orders are increasingly common, t hough there has been little evaluation of their changing use. The auth ors contrasted the use and outcomes of DNR orders for nationally repre sentative samples of Medicare patients hospitalized with specific diag noses 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 su rvival to hospital discharge of patients with DNR orders between the t wo time periods. RESULTS. After adjustment for sickness at admission a nd 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 admi ssion. Disparity in DNR order use by age, diagnosis, functional status , preadmission residence, and gender found in 1981 to 1982 was still p resent in 1985 to 1986. DNR orders were written earlier in hospitaliza tion 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 d iffer. CONCLUSIONS. Although use increased, disparities in DNR order a ssignment persisted in these 1980s data. Examination is needed into wh ether these differences persist and whether they reflect patient prefe rences. Systems should be developed to preserve and review the prefere nces of the increasing number of patients discharged after in-hospital DNR orders.