https://scholars.lib.ntu.edu.tw/handle/123456789/431106
標題: | Impact of major illnesses and geographic regions on do-not-resuscitate rate and its potential cost savings in Taiwan | 作者: | MING-TAI CHENG FUH-YUAN SHIH CHU-LIN TSAI HUNG-BIN TSAI DANIEL FU-CHANG TSAI CHENG-CHUNG FANG |
公開日期: | 1-一月-2019 | 卷: | 14 | 期: | 9 | 來源出版物: | PLoS ONE | 摘要: | © 2019 Cheng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background/Purpose Do-not-resuscitate (DNR) is a legal order that demonstrates a patient's will to avoid further suffering from advanced treatment at the end of life. The concept of palliative care is increasingly accepted, but the impacts of different major illnesses, geographic regions, and health expenses on DNR rates remain unclear. Methods This study utilized the two-million National Health Insurance (NHI) Research Database to examine the percentage of DNR rates among all deaths in hospitals from 2001 to 2011. DNR in the study was defined as no resuscitation before death in hospitals. Death records were extracted from the database and correlated with healthcare information. Descriptive statistics were compiled to examine the relationships between DNR rates and variables including major illnesses, geographic regions, and NHI spending. Results A total of 126,390 death records were extracted from the database for analysis. Among cancer-related deaths, pancreatic cancer patients had the highest DNR rate (86.99%) and esophageal cancer patients had the lowest DNR rate (71.62%). The higher DNR rate among cancer-only patients (79.53%) decreased with concomitant dialysis (66.07%) or ventilator use (57.85%). The lower DNR rates in patients with either chronic dialysis (51.27%) or ventilator use (59.10%) increased when patients experienced these two conditions concomitantly (61.31%). Although DNR rates have consistently increased over time across all regions of Taiwan, a persistent disparity was noted between the East and the South (76.89% vs. 70.78% in 2011, p < 0.01). After adjusting for potential confounders, DNR patients had significantly lower NHI spending one year prior to death ($67,553), compared with non-DNR patients. Conclusion Our study found that DNR rates varied across cancer types and decreased in cancer patients with concomitant chronic dialysis or ventilator use. Disparities in DNR rates were evident across geographic regions in Taiwan. A wider adoption of the DNR policy may achieve substantial savings in health expenses and improve patients' quality of life. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/431106 | ISSN: | 1932-6203 | DOI: | 10.1371/journal.pone.0222320 | SDG/關鍵字: | Article; artificial ventilation; biogeographic region; cancer mortality; cancer patient; controlled study; cost control; cost of illness; data base; dialysis; diseases; do not resuscitate order; esophagus cancer; hospital mortality; human; major clinical study; medical information; national health insurance; pancreas cancer; Taiwan; cost control; economics; epidemiology; ethics; factual database; geography; palliative therapy; psychology; quality of life; resuscitation; socioeconomics; Cost of Illness; Cost Savings; Databases, Factual; Geography; Humans; Palliative Care; Quality of Life; Resuscitation Orders; Socioeconomic Factors; Taiwan |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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