https://scholars.lib.ntu.edu.tw/handle/123456789/440504
標題: | Two distinct Do-Not-Resuscitate protocols leaving less to the imagination: An observational study using propensity score matching | 作者: | YEN-YUAN CHEN Gordon N.H. Connors A.F. Garland A. SHAN-CHWEN CHANG Youngner S.J. |
公開日期: | 2014 | 出版社: | BioMed Central Ltd. | 卷: | 12 | 期: | 1 | 來源出版物: | BMC Medicine | 摘要: | Background: Do-Not-Resuscitate (DNR) patients tend to receive less medical care after the order is written. To provide a clearer approach, the Ohio Department of Health adopted the Do-Not-Resuscitate law in 1998, indicating two distinct protocols of DNR orders that allow DNR patients to choose the medical care: DNR Comfort Care (DNRCC), implying DNRCC patients receive only comfort care after the order is written; and DNR Comfort Care-Arrest (DNRCC-Arrest), implying that DNRCC-Arrest patients are eligible to receive aggressive interventions until cardiac or respiratory arrest. The aim of this study was to examine the medical care provided to patients with these two distinct protocols of DNR orders.Methods: Data were collected from August 2002 to December 2005 at a medical intensive care unit in a university-affiliated teaching hospital. In total, 188 DNRCC-Arrest patients, 88 DNRCC patients, and 2,051 non-DNR patients were included. Propensity score matching using multivariate logistic regression was used to balance the confounding variables between the 188 DNRCC-Arrest and 2,051 non-DNR patients, and between the 88 DNRCC and 2,051 non-DNR patients. The daily cost of intensive care unit (ICU) stay, the daily cost of hospital stay, the daily discretionary cost of ICU stay, six aggressive interventions, and three comfort care measures were used to indicate the medical care patients received. The association of each continuous variable and categorical variable with having a DNR order written was analyzed using Student's t-test and the χ2 test, respectively. The six aggressive interventions and three comfort care measures performed before and after the order was initiated were compared using McNemar's test.Results: DNRCC patients received significantly fewer aggressive interventions and more comfort care after the order was initiated. By contrast, for DNRCC-Arrest patients, the six aggressive interventions provided were not significantly decreased, but the three comfort care measures were significantly increased after the order was initiated. In addition, the three medical costs were not significantly different between DNRCC and non-DNR patients, or between DNRCC-Arrest and non-DNR patients.Conclusions: When medical care provided to DNR patients is clearly indicated, healthcare professionals will provide the medical care determined by patient/surrogate decision-makers and healthcare professionals, rather than blindly decreasing medical care. ? 2014 Chen et al.; licensee BioMed Central Ltd. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84908087439&doi=10.1186%2fs12916-014-0146-x&partnerID=40&md5=77a772bd0798f386b5b47af5dbd311df https://scholars.lib.ntu.edu.tw/handle/123456789/440504 |
ISSN: | 1741-7015 | DOI: | 10.1186/s12916-014-0146-x | SDG/關鍵字: | antibiotic agent; fentanyl; hypertensive factor; morphine; adult; aged; analgesia; antibiotic therapy; Article; blood component therapy; cardioversion; central venous catheterization; clinical protocol; comparative study; counseling; disease severity; do not resuscitate; family decision making; female; hospice; hospitalization; hospitalization cost; human; imagination; intensive care unit; major clinical study; male; medical care; medicolegal aspect; observational study; pain; palliative therapy; patient comfort; propensity score; randomized controlled trial (topic); renal replacement therapy; sensitivity analysis; teaching hospital; terminal care; APACHE; decision making; factual database; health care cost; length of stay; middle aged; outcome assessment; resuscitation; statistical model; statistics and numerical data; United States; university hospital; Aged; APACHE; Databases, Factual; Decision Making; Female; Health Care Costs; Hospitals, University; Humans; Intensive Care Units; Length of Stay; Logistic Models; Male; Middle Aged; Ohio; Outcome Assessment (Health Care); Propensity Score; Resuscitation Orders |
顯示於: | 醫學教育暨生醫倫理學科所 |
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