Accuracy of Do Not Resuscitate (DNR) in Administrative Data. (February 2013)

• Record Type: Journal Article
• Authors: Goldman, L. Elizabeth; Chu, Philip W.; Osmond, Dennis; Bindman, Andrew
• Is Part Of: Medical care research and review. Volume 70:Number 1(2013)Supplement
• Page Start: 98
• Page End: 112
• Publication Date: 2013-02
• Subjects: do not resuscitate -- administrative data -- accuracy; Medical care -- United States -- Periodicals; Medical care -- Periodicals; Medical care -- Research -- United States -- Periodicals; Medical care -- Research -- Periodicals; Medical economics -- United States -- Periodicals; Medical economics -- Periodicals; 362.10973
• DOI: 10.1177/1077558712458455
• Languages: English
• ISSNs: 1077-5587

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.