An Examination of Do Not Resuscitate Compliance: Hospital Ownership and Cost Considerations

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Porter, P. (2015). An Examination of Do Not Resuscitate Compliance: Hospital Ownership and Cost Considerations. Unc Charlotte Electronic Theses And Dissertations.
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Abstract

My dissertation sheds light on unwanted treatment in the larger context of the Patient Self-Determination Act (PSDA). I focus specifically on the impact of Catholic hospitals on compliance with do not resuscitate (DNR) orders. Drawing from institutional approaches to organizational decision-making, I extend these approaches to end-of-life care. Two questions guide my research: does Catholic hospital ownership affect the likelihood of DNR noncompliance and does DNR noncompliance affect the total cost from the discharge, on average? To answer my questions, I used inpatient 2006 through 2009 discharge data for California hospital stays for DNR patients 65 years or older who suffered in-hospital cardiac arrest. My findings showed 28 percent of patients were resuscitated after cardiac arrest, despite a DNR order, with varying likelihood across hospital ownership. An unanticipated result was that Catholic hospitals were associated with a higher likelihood of DNR noncompliance that is similar to that of for-profit hospitals but opposite to that of non-Catholic religious hospitals. The findings also support the hypothesized relationship between DNR noncompliance and the total cost from the discharge, on average. The data demonstrated an association between race, gender, and age and DNR noncompliance. These findings suggest that the PSDA overestimates the universal acceptance of patient self-determination via DNR orders. I call for framing unwanted end-of-life care as a public health issue and, subsequently, for the inclusion of clear and precise directives for DNR orders in the PSDA.

Details
Author

Porter, Petra

Title

An Examination of Do Not Resuscitate Compliance: Hospital Ownership and Cost Considerations

Physical Description

1 online resource (186 pages) : PDF

Date

2015

Degree Granting Institution

University of North Carolina at Charlotte

Abstract

My dissertation sheds light on unwanted treatment in the larger context of the Patient Self-Determination Act (PSDA). I focus specifically on the impact of Catholic hospitals on compliance with do not resuscitate (DNR) orders. Drawing from institutional approaches to organizational decision-making, I extend these approaches to end-of-life care. Two questions guide my research: does Catholic hospital ownership affect the likelihood of DNR noncompliance and does DNR noncompliance affect the total cost from the discharge, on average? To answer my questions, I used inpatient 2006 through 2009 discharge data for California hospital stays for DNR patients 65 years or older who suffered in-hospital cardiac arrest. My findings showed 28 percent of patients were resuscitated after cardiac arrest, despite a DNR order, with varying likelihood across hospital ownership. An unanticipated result was that Catholic hospitals were associated with a higher likelihood of DNR noncompliance that is similar to that of for-profit hospitals but opposite to that of non-Catholic religious hospitals. The findings also support the hypothesized relationship between DNR noncompliance and the total cost from the discharge, on average. The data demonstrated an association between race, gender, and age and DNR noncompliance. These findings suggest that the PSDA overestimates the universal acceptance of patient self-determination via DNR orders. I call for framing unwanted end-of-life care as a public health issue and, subsequently, for the inclusion of clear and precise directives for DNR orders in the PSDA.

Genre

doctoral dissertations

Subjects--Topics

Public health
Government policy
Medical ethics

Degree

Ph.D.

Keywords

DNR
End-Of-Life Care
Health Care Costs
Hospitals
Medical Ethics
Religion

Subject Area

Public Policy

Advisor(s)

Tong, Rosemarie
Scheid, Teresa

Committee Members

Troyer, Jennifer
Rubin, Beth
Thompson, Michael

Degree Note

Thesis (Ph.D.)--University of North Carolina at Charlotte, 2015.

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Rights Holder Information

Copyright is held by the author unless otherwise indicated.

Identifier

Porter_uncc_0694D_10778

Permalink

http://hdl.handle.net/20.500.13093/etd:962