Healthcare News & Insights

DNR orders may negatively affect quality ratings

Nowadays, all hospitals are subject to ratings of their performance. And since the results of these evaluations are typically made public, facilities end up facing a lot of scrutiny. It may be warranted in some areas, but others may be unfairly making your hospital look bad – especially regarding mortality rates. 

ThinkstockPhotos-478582558A new study from the Journal of the American Medical Association (JAMA) Internal Medicine found that, when calculating death rates, patients with Do Not Resuscitate (DNR) orders aren’t accounted for separately.

What this means: Hospital death rates aren’t always painting the clearest picture of a facility’s quality of care.

Some hospitals may be taking on higher numbers of sicker patients who may not respond well to life-sustaining treatments, the study stated. And those patients are probably more likely to have a DNR on file.

Under many ratings systems, their deaths are weighted the same as those who die after prolonged health interventions. So simply looking at mortality rates may be misleading.

Study findings

The JAMA Internal Medicine study specifically examined instances where patients were admitted to the hospital with pneumonia.

Without accounting for each patient’s DNR status, hospitals with higher DNR rates had higher mortality rates. But after adjusting for patients with DNR orders, mortality rates changed for the better.

In fact, when DNR rates were taken into consideration, the mortality rate actually decreased for many facilities, which would give them a boost in the rankings. Close to half (48%) of hospitals examined would lose their status as low-performing facilities if DNR orders were taken into account when reviewing mortality rates.

Patient wishes matter

The study also mentioned another interesting correlation: Facilities treating more patients with DNR orders also received better patient satisfaction scores.

It’s likely that patients and their families who were given the option to create a DNR order were happier because they were presented with choices, and their opinions were respected throughout the process.

But the way data reporting is set up, the numbers actually penalize facilities that do respect patients’ wishes.

As stated in a Gizmodo article about the study, that means that “the high quality care of allowing patients to die without intervention if they choose to do so masks the equally high quality care of keeping them alive with interventions if they choose.”

This is clear proof that quality ratings can’t always be taken at face value when examining how well a facility cares for patients.

That said, there could be a chance that a patient, worried about a high death rate at your facility, may be wary of receiving care. Bringing up research like this study is the perfect way to ease those fears – as well as address any concerns the patient may have about his or her treatment.

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