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Impact of major illnesses and geographic regions on do-not-resuscitate rate and its potential cost savings in Taiwan


Autoři: Ming-Tai Cheng aff001;  Fuh-Yuan Shih aff001;  Chu-Lin Tsai aff001;  Hung-Bin Tsai aff002;  Daniel Fu-Chang Tsai aff003;  Cheng-Chung Fang aff001
Působiště autorů: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan aff001;  Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan aff002;  Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan aff003;  Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222320

Souhrn

Background/Purpose

Do-not-resuscitate (DNR) is a legal order that demonstrates a patient’s will to avoid further suffering from advanced treatment at the end of life. The concept of palliative care is increasingly accepted, but the impacts of different major illnesses, geographic regions, and health expenses on DNR rates remain unclear.

Methods

This study utilized the two-million National Health Insurance (NHI) Research Database to examine the percentage of DNR rates among all deaths in hospitals from 2001 to 2011. DNR in the study was defined as no resuscitation before death in hospitals. Death records were extracted from the database and correlated with healthcare information. Descriptive statistics were compiled to examine the relationships between DNR rates and variables including major illnesses, geographic regions, and NHI spending.

Results

A total of 126,390 death records were extracted from the database for analysis. Among cancer-related deaths, pancreatic cancer patients had the highest DNR rate (86.99%) and esophageal cancer patients had the lowest DNR rate (71.62%). The higher DNR rate among cancer-only patients (79.53%) decreased with concomitant dialysis (66.07%) or ventilator use (57.85%). The lower DNR rates in patients with either chronic dialysis (51.27%) or ventilator use (59.10%) increased when patients experienced these two conditions concomitantly (61.31%). Although DNR rates have consistently increased over time across all regions of Taiwan, a persistent disparity was noted between the East and the South (76.89% vs. 70.78% in 2011, p < 0.01). After adjusting for potential confounders, DNR patients had significantly lower NHI spending one year prior to death ($67,553), compared with non-DNR patients.

Conclusion

Our study found that DNR rates varied across cancer types and decreased in cancer patients with concomitant chronic dialysis or ventilator use. Disparities in DNR rates were evident across geographic regions in Taiwan. A wider adoption of the DNR policy may achieve substantial savings in health expenses and improve patients’ quality of life.

Klíčová slova:

People and places – Geographical locations – Asia – Taiwan – Engineering and technology – Equipment – Laboratory equipment – Ventilators – Medicine and health sciences – Nephrology – Medical dialysis – Health care – Palliative care – End of life care – Critical care and emergency medicine – Resuscitation – Earth sciences – Geography – Regional geography – Geographic areas


Zdroje

1. Cheng MT, Hsih FY, Tsai CL, Tsai HB, Tsai DF, Fang CC. Increased rate of DNR status in hospitalized end-of-life patients in Taiwan. Intensive Care Med. 2016;42(11):1816–7. Epub 2016/10/21. doi: 10.1007/s00134-016-4509-y 27562245.

2. Ganz FD, Benbenishty J, Hersch M, Fischer A, Gurman G, Sprung CL. The impact of regional culture on intensive care end of life decision making: an Israeli perspective from the ETHICUS study. J Med Ethics. 2006;32(4):196–9. Epub 2006/04/01. doi: 10.1136/jme.2005.012542 16574871; PubMed Central PMCID: PMC2565781.

3. Celso BG, Meenrajan S. The triad that matters: palliative medicine, code status, and health care costs. Am J Hosp Palliat Care. 2010;27(6):398–401. doi: 10.1177/1049909110363806 20332499

4. Mun E, Ceria-Ulep C, Umbarger L, Nakatsuka C. Trend of Decreased Length of Stay in the Intensive Care Unit (ICU) and in the Hospital with Palliative Care Integration into the ICU. The Permanente journal. 2016;20(4):56–61. Epub 2016/09/20. doi: 10.7812/tpp/16-036 27644048; PubMed Central PMCID: PMC5101091.

5. Wen CP, Tsai SP, Chung WS. A 10-year experience with universal health insurance in Taiwan: measuring changes in health and health disparity. Ann Intern Med. 2008;148(4):258–67. Epub 2008/02/20. 18283203.

6. Levin TT, Li Y, Weiner JS, Lewis F, Bartell A, Piercy J, et al. How do-not-resuscitate orders are utilized in cancer patients: timing relative to death and communication-training implications. Palliat Support Care. 2008;6(4):341–8. doi: 10.1017/S1478951508000540 19006588

7. Middlewood S, Gardner G, Gardner A. Dying in hospital: medical failure or natural outcome? J Pain Symptom Manage. 2001;22(6):1035–41. 11738166

8. Phua J, Kee AC, Tan A, Mukhopadhyay A, See KC, Aung NW, et al. End-of-life care in the general wards of a Singaporean hospital: an Asian perspective. J Palliat Med. 2011;14(12):1296–301. doi: 10.1089/jpm.2011.0215 22060181

9. Keam B, Oh DY, Lee SH, Kim DW, Kim MR, Im SA, et al. Aggressiveness of cancer-care near the end-of-life in Korea. Jpn J Clin Oncol. 2008;38(5):381–6. doi: 10.1093/jjco/hyn031 18411260

10. Oh DY, Kim JH, Kim DW, Im SA, Kim TY, Heo DS, et al. CPR or DNR? End-of-life decision in Korean cancer patients: a single center's experience. Support Care Cancer. 2006;14(2):103–8. 16151752

11. Kizawa Y, Tsuneto S, Hamano J, Nagaoka H, Maeno T, Shima Y. Advance directives and do-not-resuscitate orders among patients with terminal cancer in palliative care units in Japan: a nationwide survey. Am J Hosp Palliat Care. 2013;30(7):664–9. Epub 2012/10/16. doi: 10.1177/1049909112462860 23064036.

12. Juang IF, Huang CF, Huang YT. [A Comparison of Differences in Medical Treatments Patients with Do-not-resuscitate Orders Received Before Death in the Intensive Care Units in Northern Taiwan and Eastern Taiwan]. Journal of Tzu Chi University of Science and Technology. 2015;(24):1–18. Chinese. Available at http://www.airitilibrary.com/Publication/alDetailedMesh?docid=16818814-201503-201505210021-201505210021-1-18, Accessed May 31, 2019)

13. Morrison RS, Penrod JD, Cassel JB, Caust-Ellenbogen M, Litke A, Spragens L, et al. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783–90. Epub 2008/09/10. doi: 10.1001/archinte.168.16.1783 18779466.

14. Zhang B, Wright AA, Huskamp HA, Nilsson ME, Maciejewski ML, Earle CC, et al. Health care costs in the last week of life: associations with end-of-life conversations. Arch Intern Med. 2009;169(5):480–8. Epub 2009/03/11. doi: 10.1001/archinternmed.2008.587 19273778; PubMed Central PMCID: PMC2862687.

15. Ahmad AS, Mudasser S, Khan MN, Abdoun HN. Outcomes of Cardiopulmonary Resuscitation and Estimation of Healthcare Costs in Potential 'Do Not Resuscitate' Cases. Sultan Qaboos University medical journal. 2016;16(1):e27–34. Epub 2016/02/26. doi: 10.18295/squmj.2016.16.01.006 26909209; PubMed Central PMCID: PMC4746039.

16. Pinderhughes ST, Lehn JM, Kamal AH, Hutchinson R, O'Neill L, Jones CA. Expanding Palliative Medicine Across Care Settings: One Health System Experience. J Palliat Med. 2018. Epub 2018/06/30. doi: 10.1089/jpm.2017.0375 29957094.


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