“Do Not Hospitalize” Orders for Nursing Home Residents Associated With Lower Odds of Hospital, ED Transfers

March 10, 2017 | Aging Services Risk, Quality, & Safety Guidance

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​Nursing home residents who had a "do not hospitalize" (DNH) advance directive in place were less likely to be transferred to a hospital or emergency department (ED) compared with those who did not have such orders, according to a study posted online February 14, 2017, in the Journal of the American Medical Directors Association. The authors analyzed data from 43,024 New York State nursing home residents and used logistic regression to quantify the relationship between DNH orders and hospital or ED transfers. Sixty-one percent of the nursing home residents had do-not-resuscitate orders, only 6% had DNH orders, and approximately 36% had no advance directive at all. Overall, the percentage of residents with DNH orders who had hospital stays in the last 90 days (3%) was lower than the percentage of those without DNH orders who had hospital stays (7%), meaning the odds of being transferred to a hospital was 2.23 times as high among those without DNH orders.

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