Accuracy of do not resuscitate (DNR) in administrative data

Med Care Res Rev. 2013 Feb;70(1):98-112. doi: 10.1177/1077558712458455. Epub 2012 Sep 6.

Abstract

This article evaluates the accuracy of reporting do not resuscitate (DNR) orders in administrative data for use in risk-adjusted hospital assessments. We compared DNR reporting by 48 California hospitals in 2005 patient discharge data (PDD) with gold-standard assessments made by registered nurses (RNs) who reabstracted 1,673 records of patients with myocardial infarction, pneumonia, or heart failure. The PDD agreed with the RN reabstraction in 1,411 (84.3%) cases. The administrative data did not reflect a DNR order in 71 of 512 records where the RN indicated there was (14% false negative rates), and reflected a DNR order in 191 of 1,161 records where the RN indicated there was not (16% false positive rate). The accuracy of DNR was more problematic for patients who died, suggesting that hospital-reported DNR is problematic for capturing patient preferences for resuscitation that can be used for risk-adjusted outcomes assessments.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • California
  • Female
  • Heart Failure / mortality
  • Hospital Administration / standards
  • Hospital Administration / statistics & numerical data*
  • Hospital Mortality
  • Hospitals / standards
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality
  • Nursing Staff, Hospital
  • Pneumonia / mortality
  • Resuscitation Orders*
  • Risk Adjustment
  • Young Adult