Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample Analysis
Introduction: Patients from diverse sociocultural backgrounds and with differing medical conditions may have varying levels of acceptance of advanced care planning and palliative care. Methods: We performed a retrospective analysis of the National Inpatient Sample for patients discharged from Januar...
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Mary Ann Liebert
2024-10-01
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| Series: | Palliative Medicine Reports |
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| Online Access: | https://www.liebertpub.com/doi/10.1089/pmr.2024.0030 |
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| author | Jean-Sebastien Rachoin Nicole Debski Krystal Hunter Elizabeth Cerceo |
| author_facet | Jean-Sebastien Rachoin Nicole Debski Krystal Hunter Elizabeth Cerceo |
| author_sort | Jean-Sebastien Rachoin |
| collection | DOAJ |
| description | Introduction: Patients from diverse sociocultural backgrounds and with differing medical conditions may have varying levels of acceptance of advanced care planning and palliative care. Methods: We performed a retrospective analysis of the National Inpatient Sample for patients discharged from January 1, 2016, to December 31, 2019, with conditions associated with frequently terminal conditions. We recorded demographic variables, do not resuscitate (DNR) status, and palliative care (PC) status and analyzed the associations between outcomes, mortality, and length of stay (LOS). Results: A total of 23,402,637 patient records were included in the study, of which 2% were DNR and PC, 5% were DNR only, and 1% was PC only. From 2016 to 2019, the percentage of patients with PC increased from 2.55% to 3.27% and DNR from 6.31% to 7.7%. Black patients were less likely to have DNR status (odds ratio [OR] 0.72 [0.71–0.72]) but had similar PC rates. Male patients were less likely to have a DNR order in place (OR 0.89 [0.89–0.89]) but more likely to be in PC (OR 1.05 [1.04–1.05]). The diagnoses with the highest association with DNR status were lung cancer (OR 4.1 [4.0–4.5]), pancreatic cancer (OR 4.6 [4.5–4.7]), and sepsis (OR 2.9 [2.9–2.9]) The diagnoses most associated with PC were lung cancer (OR 6.3 [6.2–6.4]), pancreatic cancer (OR 8.1 [7.1–8.3]), colon cancer (OR 4.9 [4.8–5.1]), and senile brain degeneration of the brain OR 6.5 [5.3–7.9]). Mortality and LOS decreased between 2016 and 2019, but hospital charges increased (p < 0.001). Black race and male gender were associated with higher inpatient mortality (OR 1.12 [1.12–1.14]), LOS, and hospital charges. Conclusion: In the United States, the proportion of hospitalized patients with DNR, PC, and DNR with PC increased from 2016 to 2019. Overall, inpatient mortality and LOS fell, but hospital charges per patient increased. Significant gender and ethnic differences emerged. Black patients and males were less likely to have DNR status and had higher inpatient mortality, LOS, and hospital charges. |
| format | Article |
| id | doaj-art-701ff65573fc49a6826411ca67e1ebed |
| institution | DOAJ |
| issn | 2689-2820 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Mary Ann Liebert |
| record_format | Article |
| series | Palliative Medicine Reports |
| spelling | doaj-art-701ff65573fc49a6826411ca67e1ebed2025-08-20T02:59:07ZengMary Ann LiebertPalliative Medicine Reports2689-28202024-10-015133133910.1089/pmr.2024.0030Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample AnalysisJean-Sebastien Rachoin0Nicole Debski1Krystal Hunter2Elizabeth Cerceo3Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA.Cooper Medical School of Rowan University, Camden, New Jersey, USA.Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA.Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA.Introduction: Patients from diverse sociocultural backgrounds and with differing medical conditions may have varying levels of acceptance of advanced care planning and palliative care. Methods: We performed a retrospective analysis of the National Inpatient Sample for patients discharged from January 1, 2016, to December 31, 2019, with conditions associated with frequently terminal conditions. We recorded demographic variables, do not resuscitate (DNR) status, and palliative care (PC) status and analyzed the associations between outcomes, mortality, and length of stay (LOS). Results: A total of 23,402,637 patient records were included in the study, of which 2% were DNR and PC, 5% were DNR only, and 1% was PC only. From 2016 to 2019, the percentage of patients with PC increased from 2.55% to 3.27% and DNR from 6.31% to 7.7%. Black patients were less likely to have DNR status (odds ratio [OR] 0.72 [0.71–0.72]) but had similar PC rates. Male patients were less likely to have a DNR order in place (OR 0.89 [0.89–0.89]) but more likely to be in PC (OR 1.05 [1.04–1.05]). The diagnoses with the highest association with DNR status were lung cancer (OR 4.1 [4.0–4.5]), pancreatic cancer (OR 4.6 [4.5–4.7]), and sepsis (OR 2.9 [2.9–2.9]) The diagnoses most associated with PC were lung cancer (OR 6.3 [6.2–6.4]), pancreatic cancer (OR 8.1 [7.1–8.3]), colon cancer (OR 4.9 [4.8–5.1]), and senile brain degeneration of the brain OR 6.5 [5.3–7.9]). Mortality and LOS decreased between 2016 and 2019, but hospital charges increased (p < 0.001). Black race and male gender were associated with higher inpatient mortality (OR 1.12 [1.12–1.14]), LOS, and hospital charges. Conclusion: In the United States, the proportion of hospitalized patients with DNR, PC, and DNR with PC increased from 2016 to 2019. Overall, inpatient mortality and LOS fell, but hospital charges per patient increased. Significant gender and ethnic differences emerged. Black patients and males were less likely to have DNR status and had higher inpatient mortality, LOS, and hospital charges.https://www.liebertpub.com/doi/10.1089/pmr.2024.0030DNRethnic disparitiesgender disparitieshealth equitypalliative care |
| spellingShingle | Jean-Sebastien Rachoin Nicole Debski Krystal Hunter Elizabeth Cerceo Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample Analysis Palliative Medicine Reports DNR ethnic disparities gender disparities health equity palliative care |
| title | Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample Analysis |
| title_full | Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample Analysis |
| title_fullStr | Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample Analysis |
| title_full_unstemmed | Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample Analysis |
| title_short | Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample Analysis |
| title_sort | factors associated with do not resuscitate status and palliative care in hospitalized patients a national inpatient sample analysis |
| topic | DNR ethnic disparities gender disparities health equity palliative care |
| url | https://www.liebertpub.com/doi/10.1089/pmr.2024.0030 |
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