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{
    "pk": 8749,
    "title": "Epidemiology of Advance Directives in Extended Care Facility Patients Presenting to the Emergency Department",
    "subtitle": null,
    "abstract": "Introduction:\n We conducted an epidemiologic evaluation of advance directives and do-not-resuscitate (DNR) prevalence among residents of extended care facilities (ECF) presenting to the emergency department (ED).\nMethods:\n We performed a retrospective medical record review on ED patients originating from an ECF. Data were collected on age, sex, race, triage acuity, ED disposition, DNR status, power-of attorney (POA) status, and living will (LW) status. We generated descriptive statistics, and used logistic regression to evaluate predictors of DNR status.\nResults:\n A total of 754 patients over 20 months met inclusion criteria; 533 (70.7%) were white, 351 (46.6%) were male, and the median age was 66 years (IQR 54-78). DNR orders were found in 124 (16.4%, 95% CI [13.9-19.1%]) patients. In univariate analysis, there was a significant difference in DNR by gender (10.5% female vs. 6.0% male with DNR, p=0.013), race (13.4% white vs. 3.1% non-white with DNR, p=0.005), and age (4.0% <65 years; 2.9% 65-74 years, p=0.101; 3.3% 75-84 years, p=0.001; 6.2% >84 years, p<0.001). Using multivariate logistic regression, we found that factors associated with DNR status were gender (OR 1.477, p=0.358, note interaction term), POA status (OR 6.612, p<0.001), LW (18.032, p<0.001), age (65-74 years OR 1.261, p=0.478; 75-84 years OR 1.737, p=0.091, >84 years OR 5.258, P<0.001), with interactions between POA and gender (OR 0.294, P=0.016) and between POA and LW (OR 0.227, p<0.005). Secondary analysis demonstrated that DNR orders were not significantly associated with death during admission (p=0.084).\nConclusion:\n Age, gender, POA, and LW use are predictors of ECF patient DNR use. Further, DNR presence is not a predictor of death in the hospital.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Advance Directive"
        },
        {
            "word": "DNR"
        },
        {
            "word": "Extended Care Facility"
        },
        {
            "word": "Emergency Medicine"
        }
    ],
    "section": "Ethical and Legal Issues",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/8548j6wd",
    "frozenauthors": [
        {
            "first_name": "Jessica",
            "middle_name": "",
            "last_name": "Wall",
            "name_suffix": "",
            "institution": "Penn Presbyterian Medical Center, Department of Emergency Medicine, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Brain",
            "middle_name": "",
            "last_name": "Hiestand",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Jeffrey",
            "middle_name": "",
            "last_name": "Caterino",
            "name_suffix": "",
            "institution": "Ohio State University, Department of Emergency Medicine, Columbus, Ohio",
            "department": "None"
        }
    ],
    "date_submitted": "2015-02-08T22:23:27Z",
    "date_accepted": "2015-02-08T22:23:27Z",
    "date_published": "2015-11-16T23:14:15Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/8749/galley/5011/download/"
        }
    ]
}