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Correspondence: Address correspondence to Aram Dobalian, PhD, JD, Assistant Professor, Department of Health Services Administration, University of Florida, PO Box 100195, Gainesville, FL 32610-0195. E-mail: adobalia{at}hp.ufl.edu.
Purpose: This study sought to determine whether nursing homes comply with residents' do-not-hospitalize (DNH) orders prohibiting inpatient hospitalization. Design and Methods: With the use of data from the nationally representative 1996 Nursing Home Component of the Medical Expenditure Panel Survey, a multivariate logistic regression model was developed. Results: Three percent of residents had DNH orders. These residents were half as likely to be hospitalized. Residents in not-for-profit or public facilities were less likely to be hospitalized than those in for-profit homes. Hospitalization was more likely among men, racial or ethnic minorities, those with more diagnosed health conditions, and those in facilities in the South compared with those in the Midwest. Hospitalized residents with DNH orders had no limitations of activities of daily living, were not located in hospital-based nursing homes, were less likely to be in a for-profit facility, and were sicker than nonhospitalized residents with DNH orders. Implications: Improved education regarding advance directives, particularly DNH orders, is necessary for health care practitioners and patients. More consistent and rigorous policies should be implemented in nursing facilities.
Key Words: Advance directives • End-of-life care • Transfers • Nursing homes • Appropriateness
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