Health Care Expenses for COPD with Late Do-Not-Resuscitate (DNR) Decisions Escalate Nearly 2-Fold in Final Admission of Life

Abstract

Background: Our previous study showed 70% of do-not-resuscitate (DNR) directive of chronic obstructive pulmonary disease (COPD) patients were made prior to their last hospital admission. The objective of the study was to compare the end-of-life resource use among COPD decedents on the different status of DNR decisions. Methods: A retrospective chohort analysis form electronic medical records (EMR) was conducted in a teaching hospital in Taiwan. Those who died of COPD were enrolled based on the primary and secondary cause of death. We classified the cohort into three groups as without DNR decision (No DNR), with an early DNR (EDNR) decision (prior to last hospital admission) and with a late DNR (LDNR) decision. Multivariate linear regression analysis was used to determine the independent predictors of cost. Results: We enrolled 361 subjects and 318 (88.1%) of them died with a DNR directive, however only 31.4% were EDNR. EDNR group were less in ICU admission, less in total medical expenditures, and less in receiving invasive procedures than other two groups. The total medical cost during the last admission escalated approximately nearly 2-Fold in LDNR group than in EDNR group. About 60 % of medical expenses were significantly attributed to factors as LDNR, age, hospital stays and comorbidities by multivariate linear regression model. Conclusion: LDNR is also a kind of low value care lead to higher intensive care resource use and focused on prolonging life in COPD patients. It indicated an unmet need and necessary of early share decisions with advanced COPD patients.