McAuley William J, Travis Shirley S
Health Behavior and Administration, College of Health and Human Services, University of North Carolina, Charlotte, North Carolina, USA.
Am J Hosp Palliat Care. 2003 Sep-Oct;20(5):353-9. doi: 10.1177/104990910302000509.
This study was conducted to determine whether two types of advance directives exist for individuals residing in long-term care facilities. Findings were based on data from the Medical Expenditure Panel Study-Nursing Home Component (MEPS-NHC), a survey using a two-stage stratified probability sample of nursing homes and residents to produce valid national estimates of the nursing home population in the United States. The two types of advance directives included basic, i.e., living will or do-not-resuscitate (DNR) order, and progressive (do-not-hospitalize order or orders restricting feeding, medication, or other treatment). Approximately 59 percent of long-term care residents had a basic advance directive, 9 percent have a progressive directive, and 60 percent have some type of directive. Logistic regression results indicate that the factors associated with the likelihood of each type of directive differ considerably, and only two variables (African American ethnicity and less time in the facility) were associated with a reduced likelihood of having either type of directive. Our results indicate that the two proposed types of advance directives are distinct with regard to the variables predicting each.
本研究旨在确定居住在长期护理机构的个人是否存在两种类型的预先医疗指示。研究结果基于医疗支出面板调查——疗养院部分（MEPS-NHC）的数据，该调查采用两阶段分层概率抽样方法对疗养院和居民进行抽样，以得出美国疗养院人口的有效全国估计数。这两种类型的预先医疗指示包括基本指示，即生前遗嘱或不进行心肺复苏（DNR）医嘱，以及进阶指示（不入院治疗医嘱或限制喂食、用药或其他治疗的医嘱）。约59%的长期护理居民有基本预先医疗指示，9%有进阶指示，60%有某种类型的指示。逻辑回归结果表明，与每种指示可能性相关的因素差异很大，只有两个变量（非裔美国人种族和在机构中的时间较短）与拥有任何一种指示的可能性降低相关。我们的结果表明，就预测每种指示的变量而言，所提出的两种类型的预先医疗指示是不同的。
