Dobalian Aram
Department of Health Services Administration, University of Florida, PO Box 100195, Gainesville, FL 32610-0195, USA.
Gerontologist. 2004 Apr;44(2):159-65. doi: 10.1093/geront/44.2.159.
This study sought to determine whether nursing homes comply with residents' do-not-hospitalize (DNH) orders prohibiting inpatient hospitalization.
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.
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.
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.
本研究旨在确定疗养院是否遵守禁止住院治疗的居民“不要住院”（DNH）医嘱。
利用具有全国代表性的1996年医疗支出小组调查疗养院部分的数据，建立了多元逻辑回归模型。
3%的居民有DNH医嘱。这些居民住院的可能性只有一半。非营利性或公共设施中的居民比营利性疗养院中的居民住院可能性更小。与中西部地区相比，男性、少数种族或族裔、诊断出健康问题较多的居民以及南部地区设施中的居民住院的可能性更大。有DNH医嘱的住院居民日常生活活动没有受限，不住在医院附属的疗养院，在营利性机构中的可能性较小，并且比有DNH医嘱的非住院居民病情更严重。
有必要为医护人员和患者提供关于预立医疗指示，特别是DNH医嘱的更好教育。疗养院应实施更一致、更严格的政策。
