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Invited Commentary
January 2016

Implications of Including Do-Not-Resuscitate Status in Hospital Mortality Measures

Author Affiliations
  • 1Center for Healthcare Innovation and Delivery Science, NYU Langone Medical Center, New York, New York
  • 2Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York
  • 3Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, New York
JAMA Intern Med. 2016;176(1):105-106. doi:10.1001/jamainternmed.2015.6845

In 2009, exaggerated claims of “death panels” prevented Medicare from covering end-of-life discussions in ambulatory practice. Now, Medicare has proposed coverage of such discussions,1 and an increasing number of patients are presenting to the hospital with established goals of care and end-of-life wishes. Nearly half of Medicare patients now die in hospice care, up from less than a quarter in 2000.2 Quality measurement, however, has not kept up with the changing approach to end-of-life care. None of Medicare’s publicly reported mortality measures includes do-not-resuscitate (DNR) status in risk adjustment, largely because such data are not routinely reported by hospitals, but also in part because of an underlying assumption that the increased mortality risk of such patients can be accounted for by comorbidity adjustment.

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