Abstract 20050: Impact of Median Household Income and Hospital Variation in the Utilization of Do-not-resuscitate Order in Cardiac Arrest: A National Perspective
Background: The factors determining DNR status in patients (pts) with cardiac arrest have not been well elucidated.
Objective: The goal of our study was to assess impact of median household income and inter-hospital variation in utilization of DNR in Cardiac arrest.
Methods: We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) database from 2011 using the ICD-9-CM code for cardiac arrest (427.5) as principal diagnosis. We defined pts’ DNR status with ICD code - V49.86 as a secondary diagnosis. Pts with age < 18 were excluded. NIS represents 20% of all US hospital pts. We built a hierarchical two level model adjusted for multiple confounding factors. Discrimination power of models was assessed using c statistics. Inter class correlation (ICC) and Median Odds Ratio (MOR) were generated from the hierarchical model.
Results: We identified 1854 pts (weighted: 8915) with cardiac arrest across 1854 hospitals in the US, out of which 1.87% pts (366 pts, weighted: 1755) opted for DNR. Pts with higher median household income had decreased utilization of DNR (OR, 95% CI, P-Value) in 4th quartile: 0.59, 0.45-0.78, p<0.001, as compared to all other quartile. Also, with every 10 year increase in age, the rate of DNR increased (1.25, 1.18-1.32, p < 0.001). There was no statistically significant difference in other variables such as female gender, weekend admission, insurance type, teaching status of the hospital or hospital volume. C-statistics of model to generate ICC and MOR was 0.90. ICC was 60.6, which indicates that approximately 60.6 % of variation in utilization of DNR was attributable to the behavior of individual hospitals, and MOR was 8.5 which indicates that a randomly selected patient receiving DNR at a particular hospital would have approximately 9-fold higher odds of receiving DNR than an identical patient at a different randomly selected hospital.
Conclusion: Our study highlights vast variation in utilization of DNR in randomly selected 2 different hospitals with cardiac arrest pts. It also indicates a disparity in utilization of DNR orders in Pts with higher median household income as compared to lower household income.
Author Disclosures: S. Lahewala: None. S. Solanki: None. N. Patel: None. N.J. Patel: None. A. Patel: None. G. Dhaduk: None. C. Bambhroliya: None. D. Patel: None. S. Arora: None. N. Patel: None. A. Deshmukh: None. A. Badheka: None. U. Gidwani: None. T. Schreiber: None. C. Grines: None.
- © 2014 by American Heart Association, Inc.