State variation in nursing home mortality outcomes according to do-not-resuscitate status

Background. This study compares mortality outcomes of Medicaid-reimbursed n ursing home residents with and without do-not-resuscitate (DNR) orders in t wo diverse states. Methods. We used 1994 Minimum Data Set Plus (MDS+) information on 3215 nurs ing home residents from two states. We used Kaplan-Meier analyses to examin e unadjusted mortality among those with and without DNR orders across state s. We used a proportional hazard regression with main and interaction varia bles to model the likelihood of survival in the nursing home. Results. Approximately 27% of nursing home residents with DNR orders in Sta te A die within the year, and approximately 40% of nursing home residents w ith DNR orders in State B die within the year. Regression results indicate that neither having a DNR order nor state of residence were independently a ssociated with mortality. However, residing in State B and having a DNR ord er was associated with an increased risk of mortality compared with all oth ers in the sample (risk ratio = 1.73; 95% confidence interval = 1.09, 2.75) . Conclusion. This study demonstrates that DNR orders are associated with var ying mortality across states. Future research is needed to identify the rea sons why state level differences exist.