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

^a Section of General Internal Medicine, Department of Medicine, The University of Chicago, Illinois
^b School of Public Health, University of Illinois at Chicago

Brian L. Egleston, Section of General Internal Medicine, Department of Medicine, The University of Chicago, MC 2007, 5841 S. Maryland Avenue, Chicago, IL 60637 E-mail: beglesto{at}medicine.bsd.uchicago.edu.

Decision Editor: William B. Ershler, MD

Background. This study compares mortality outcomes of Medicaid-reimbursed nursing home residents with and without do-not-resuscitate (DNR) orders in two diverse states.

Methods. We used 1994 Minimum Data Set Plus (MDS+) information on 3215 nursing home residents from two states. We used Kaplan-Meier analyses to examine unadjusted mortality among those with and without DNR orders across states. We used a proportional hazard regression with main and interaction variables to model the likelihood of survival in the nursing home.

Results. Approximately 27% of nursing home residents with DNR orders in State A die within the year, and approximately 40% of nursing home residents with DNR orders in State B die within the year. Regression results indicate that neither having a DNR order nor state of residence were independently associated with mortality. However, residing in State B and having a DNR order was associated with an increased risk of mortality compared with all others in the sample (risk ratio = 1.73; 95% confidence interval = 1.09, 2.75).

Conclusion. This study demonstrates that DNR orders are associated with varying mortality across states. Future research is needed to identify the reasons why state level differences exist.