An Examination of Do Not Resuscitate Compliance: Hospital Ownership and Cost Considerations
1 online resource (186 pages) : PDF
University of North Carolina at Charlotte
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.
DNREND-OF-LIFE CAREHEALTH CARE COSTSHOSPITALSMEDICAL ETHICSRELIGION
Tong, RosemarieScheid, Teresa
Troyer, JenniferRubin, BethThompson, Michael
Thesis (Ph.D.)--University of North Carolina at Charlotte, 2015.
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