Do-Not-Hospitalize Orders Make a Difference for Nursing Home Residents, Even Those with Dementia
Programs that encourage advance care planning have shown positive results, including increased palliative care referrals, improved end-of-life care, and fewer unnecessary hospitalizations. Now a new study in JAMDA suggests that nursing home residents who had Do-Not-Hospitalize (DNH) orders had significantly fewer transfers to the hospital or emergency department (ED). The article, “Are Hospital/ED Transfers Less Likely Among Nursing Home Residents with Do-Not-Hospitalize Orders?” appears in the May issue of JAMDA.
In the study, the researchers looked at medical data for over 6,000 residents in Medicare- and Medicaid-certified nursing homes in New York. They found that 36% of residents did not have an advance directive; but, of those, only 6% had DNH orders. However, residents with DNH orders had significantly fewer hospital stays in the past 90 days than those without. They also had fewer ED visits. Residents with a dementia diagnoses who had DNH orders also had significantly fewer hospital stays than dementia patients without. However, there was no difference in the number of ED visits.
The authors concluded that their results show that residents’ end-of-life decisions were respected and honored. They suggested that further efforts should be made to encourage nursing home residents to complete advance directives to promote integration of individuals’ values, goals, and wishes in guiding care provision toward the end of life.
The study was conducted by researchers at Rutgers University, Camden, NJ; the Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany; and New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany.