State Variation in Nursing Home Mortality Outcomes According to Do-Not-211 Resuscitate Status

摘要

This study compares mortality outcomes of Medicaid-reimbursed nursing home211u001eresidents with and without do-not-resuscitate (DNR) orders in two diverse states. 211u001eWe used 1994 Minimum Data Set Plus (MDS+) information on 3,215 nursing home 211u001eresidents from two states. We used Kaplan-Meier analyses to examine unadjusted 211u001emortality among those with and without DNR orders across states. We used a 211u001eproportional hazard regression with main and interaction variables to model the 211u001elikelihood of survival in the nursing home. Approximately 27% of nursing home 211u001eresidents with DNR orders in State A within the year, and approximately 40% of 211u001enursing home residents with DNR orders in State B die within the year. Regression 211u001eresults indicate that neither having a DNR order nor state of residence were 211u001eindependently associated with mortality. However, residing in State B and having 211u001ea DNR order was associated with an increased risk of mortality compared with all 211u001eothers in the sample (RR-1.73, 95% CI-1.09, 2.75). This study demonstrates that 211u001eDNR orders are associated with varying mortality across states. Future research 211u001eis needed to identify the reasons why state level differences exist.