Consequences of end-of-life physician orders: Economic and hospital policy implications.

Persistent Link:
http://hdl.handle.net/10150/186251
Title:
Consequences of end-of-life physician orders: Economic and hospital policy implications.
Author:
Lindon, James Lee.
Issue Date:
1993
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
The University Medical Center in Tucson, Arizona developed and implemented a procedure-specific Limitation of Medical Care (LMC) form on December 1, 1989 to address medical futility and lack of clarity in do-not-attempt-resuscitation (DNAR) orders. A retrospective review of two years of data, with 300 usable responses, showed an increased amount of participation by patients and their surrogates in the DNAR decision with the LMC form. Use of the form was also associated with an increased number of medical interventions specified to be withheld after a DNAR or LMC order was written. There was no decrease in expenditures or length of survival associated with use of the form, nor was there a decrease in the number of codes called for patients who had an order that resuscitation was not to be attempted. An average $13,347 of charges were accrued in the ICU for patients in the pre-form group, $4,314 on average being after a DNAR order was written. An average $21,957 of charges were accrued in the ICU for patients in the post-form group, $8,733 on average being after a DNAR order was written. An average $20,523 of total charges were accrued for patients in the pre-form group, $7,156 on average being after a DNAR order was written. An average $29,830 of total charges were accrued in the ICU for patients in the post-form group, $12,550 on average being after a DNAR order was written. Recommendations for the UMC Bioethics Committee and future research suggestions are presented.
Type:
text; Dissertation-Reproduction (electronic)
Keywords:
Terminal care -- Economic aspects.; CPR (First aid) -- Economic aspects.
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Pharmacy Practice; Graduate College
Degree Grantor:
University of Arizona
Committee Chair:
Draugalis, JoLaine

Full metadata record

DC FieldValue Language
dc.language.isoenen_US
dc.titleConsequences of end-of-life physician orders: Economic and hospital policy implications.en_US
dc.creatorLindon, James Lee.en_US
dc.contributor.authorLindon, James Lee.en_US
dc.date.issued1993en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractThe University Medical Center in Tucson, Arizona developed and implemented a procedure-specific Limitation of Medical Care (LMC) form on December 1, 1989 to address medical futility and lack of clarity in do-not-attempt-resuscitation (DNAR) orders. A retrospective review of two years of data, with 300 usable responses, showed an increased amount of participation by patients and their surrogates in the DNAR decision with the LMC form. Use of the form was also associated with an increased number of medical interventions specified to be withheld after a DNAR or LMC order was written. There was no decrease in expenditures or length of survival associated with use of the form, nor was there a decrease in the number of codes called for patients who had an order that resuscitation was not to be attempted. An average $13,347 of charges were accrued in the ICU for patients in the pre-form group, $4,314 on average being after a DNAR order was written. An average $21,957 of charges were accrued in the ICU for patients in the post-form group, $8,733 on average being after a DNAR order was written. An average $20,523 of total charges were accrued for patients in the pre-form group, $7,156 on average being after a DNAR order was written. An average $29,830 of total charges were accrued in the ICU for patients in the post-form group, $12,550 on average being after a DNAR order was written. Recommendations for the UMC Bioethics Committee and future research suggestions are presented.en_US
dc.typetexten_US
dc.typeDissertation-Reproduction (electronic)en_US
dc.subjectTerminal care -- Economic aspects.en_US
dc.subjectCPR (First aid) -- Economic aspects.en_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplinePharmacy Practiceen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.chairDraugalis, JoLaineen_US
dc.contributor.committeememberIserson, Kennethen_US
dc.contributor.committeememberCoons, Stephenen_US
dc.contributor.committeememberByerly, Henryen_US
dc.contributor.committeememberBuchanan, Allenen_US
dc.identifier.proquest9328556en_US
dc.identifier.oclc703609505en_US
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