The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #65985

Aram Dobalian, PhD, MPH, JD, Health Services Administration, University of Florida, P.O. Box 100195, Gainesville, FL 32610-0195, 352-273-6081, adobalia@hp.ufl.edu

Purpose: To determine nursing resident and facility characteristics associated with do-not-hospitalize (DNH) orders and whether nursing homes comply with residents’ DNH orders prohibiting inpatient hospitalization. Design and Methods: Using data from the nationally representative 1996 Nursing Home Component of the Medical Expenditure Panel Survey, we developed a multivariate logistic regression model. Results: Three percent of residents had DNH orders. These residents were approximately half as likely to be hospitalized (odds ratio, 0.43; 95% confidence interval, 0.28-0.67). Residents in not for-profit or public facilities were less likely to be hospitalized compared to those in for-profit homes. Hospitalization was more likely among males, racial/ethnic minorities, those with more diagnosed health conditions, and those in facilities in the South compared to those in the Midwest. Hospitalized residents with DNH orders had no ADL limitations, were not located in hospital-based nursing homes, were less likely to be in a for-profit facility, and were sicker than non-hospitalized residents with DNH orders. Hospitalized residents with DNH orders were more likely to have Alzheimer’s. Implications: In general, nursing homes comply with resident preferences to forego hospitalization as expressed in their DNH orders. Proponents of the use of advance directives to promote patient autonomy and self-determination should be encouraged by this result. Nevertheless, 13% of residents with DNH orders were hospitalized, suggesting that nursing homes need to undertake additional measures to ensure that patient preferences for medical care are honored. These transfers to high-cost facilities, if indeed inappropriate, provide no societal benefit.

Learning Objectives:

At the conclusion of the session, the participant will be able to:
• Identify indicators of do-not-hospitalize orders among nursing home residents.
• List indicators that link do-not-hospitalize orders with facility compliance.
• Identify areas of concern for ethicists and policy-makers regarding patient preferences for medical care.

Keywords: End-of-Life Care, Long-Term Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.