Do not resuscitate orders impact hospital rankings, study finds

Including patient decisions about life-sustaining treatments, such as do not resuscitate orders, in the statistical models hospitals use to determine their rankings results in changes that could impact ratings, reimbursements and financial penalties, according to a JAMA Internal Medicine study.

"Our findings suggest that current methods of comparing hospitals, which do not account for patient DNR status, penalize potentially high-quality hospitals admitting a larger proportion of patients who had chosen to forego resuscitation. Therefore, accounting for DNR status in programs that compare hospital mortality outcomes may substantially affect publicly reportable hospital rankings and hospital reimbursements," Allan Walkey, MD, assistant professor of medicine at Boston University School of Medicine, a physician at Boston Medical Center and corresponding author for the study, said in a statement.

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The authors concluded the findings could have significant ramifications for the methods hospitals use to assess patient outcomes and quality. They both reinforce the importance of collecting patient data on life-sustaining care decisions and the need to account for those decisions when comparing hospitals. Additionally, the research contradicts the thought that hospitals with more patients choosing "DNR" status were poorer, as those hospitals actually had higher satisfaction ratings, according to the authors.

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