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


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Článek vyšel v časopise

PLOS One


2019 Číslo 9
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