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- L Elizabeth Goldman, Philip W Chu, Dennis Osmond, and Andrew Bindman.
- University of California-San Francisco, San Francisco, CA 94110, USA. legoldman@medsfgh.ucsf.edu
- Med Care Res Rev. 2013 Feb 1;70(1):98-112.
AbstractThis 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.
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