JAMDA
Volume 8, Issue 2 , Pages 91-97 , February 2007

Do Orders Limiting Aggressive Treatment Impact Care for Acute Myocardial Infarction?

  • Tiffany A. Radcliff, PhD

      Affiliations

    • VA Eastern Colorado Healthcare System, HSR&D TREP for Long-term Care Research, Denver, CO
    • Division of Health Care Policy & Research, University of Colorado Health Sciences Center, Aurora, CO
    • T.A.R. receives salary support through the US Department of Veterans Affairs Health Services Research & Development Targeted Research Enhancement Program at the Denver VA Medical Center.
    • Corresponding Author InformationAddress correspondence to Tiffany A. Radcliff, PhD, 1055 Clermont Street, MS 151, Denver, CO 80220.
    • ,
  • Aram Dobalian, PhD, JD

      Affiliations

    • VA Greater Los Angeles Healthcare System HSR&D, Center for the Study of Healthcare Provider Behavior, Sepulveda, CA
    • Department of Health Services, University of California, Los Angeles, CA.
    • A.D. is funded by a Veterans Administration Health Services Research & Development Merit Review Entry Program award (MRP 03-328).
    • ,
  • Cari Levy, MD

      Affiliations

    • VA Eastern Colorado Healthcare System, HSR&D TREP for Long-term Care Research, Denver, CO
    • Division of Health Care Policy & Research, University of Colorado Health Sciences Center, Aurora, CO

References 

  1. Murphy D. Improving advance directives for healthy older people. J Am Geriatr Soc. 1990;38:1251–1256
  2. Lo B. Unanswered questions about DNR orders. JAMA. 1991;265(14):1874–1875
  3. Joseph C, Wanlass W. DNR orders. J Am Geriatr Soc. 1991;39(11):1142
  4. Goodman MD, Tarnoff M, Slotman GJ. Effect of advance directives on the management of elderly critically ill patients. Crit Care Med. 1998;26(4):701–704
  5. Fischer GS, Tulsky JA, Rose MR, et al. Patient knowledge and physician predictions of treatment preferences after discussion of advance directives. J Gen Intern Med. 1998;13(7):447–454
  6. Gordon NP, Shade SB. Advance directives are more likely among seniors asked about end-of-life care preferences. Arch Intern Med. 1999;159(7):701–704
  7. Youngner SJ. Do-not-resuscitate orders: No longer secret, but still a problem. Hastings Cent Rep. 1987;17(1):24–33
  8. Sulmasy DP, Geller G, Levine DM, Faden R. The quality of mercy: Caring for patients with do not resuscitate orders. JAMA. 1992;267:682–686
  9. O’Toole EE, Youngner SJ, Juknialis BW, et al. Evaluation of a treatment limitation policy with a specific treatment-limiting order page. Arch Intern Med. 1994;154:425–432
  10. Levy CR, Fish R, Kramer AM. Site of death in the hospital versus nursing home of Medicare skilled nursing facility residents admitted under Medicare’s Part A Benefit. J Am Geriatr Soc. 2004;52(8):1247–1254
  11. Beach MC, Morrison RS. The effect of do-not-resuscitate orders on physician decision-making. J Am Geriatr Soc. 2002;50(12):2057–2061
  12. Danis M, Southerland LI, Garrett JM, et al. A prospective study of advance directives for life-sustaining care. N Engl J Med. 1991;324(13):882–888
  13. Levin JR, Wenger NS, Ouslander JG, et al. Life-sustaining treatment decisions for nursing home residents: Who discusses, who decides and what is decided?. J Am Geriatr Soc. 1999;47(1):82–87
  14. Shepardson LB, Youngner SJ, Speroff T, Rosenthal GE. Increased risk of death in patients with do-not-resuscitate orders. Med Care. 1999;37(8):727–737
  15. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction—summary article: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol. 2002;40(7):1366–1374
  16. Marciniak TA, Ellerbeck EF, Radford MJ, et al. Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project. JAMA. 1998;279(17):1351–1357
  17. Ryan TJ, Anderson JL, Antman EM, et al. ACC/AHA Guidelines for the Management of Patients with Acute Myocardial Infarction. J Am Coll Cardiol. 1996;28(5):1328–1428
  18. Jencks SF. HCFA’s Health Care Quality Improvement Program and the Cooperative Cardiovascular Project. Ann Thorac Surg. 1994;58(6):1858–1862
  19. Jencks SF, Cuerdon T, Burwen DR, et al. Quality of medical care delivered to Medicare beneficiaries: A profile at state and national levels. JAMA. 2000;284(13):1670–1676
  20. Krumholz HM, Radford MJ, Ellerbeck EF, et al. Aspirin in the treatment of acute myocardial infarction in elderly Medicare beneficiaries (Patterns of use and outcomes). Circulation. 1995;92(10):2841–2847
  21. Krumholz HM, Wang Y, Radford M, Marciniak T. In-hospital mortality versus 30-day mortality among Medicare beneficiaries with AMI: Implications for the evaluation of the quality of care. Suppl. Circulation. 1996;94(1):I–51
  22. Vogel RA. HCFA’s Cooperative Cardiovascular Project: A nationwide quality assessment of acute myocardial infarction. Clin Cardiol. 1994;17(7):354–356
  23. Allison JJ, Kiefe CI, Centor RM, et al. Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction. J Gen Intern Med. 1996;11(12):736–743
  24. Ayanian JZ, Udvarhelyi S, Gastonis CA, Epstein AM. Racial differences in the use of revascularization procedures after coronary angiography. CLP JAMA. 1993;269(20):2642–2646
  25. Gan SC, Beaver SK, Houck PM, et al. Treatment of acute myocardial infarction and 30-day mortality among men and women. N Engl J Med. 2000;343(1):8–15
  26. McLaughlin TJ, Soumerai SB, Willison DJ, et al. Adherence to national guidelines for drug treatment of suspected acute myocardial infarction: Evidence for undertreatment in women and the elderly. [published erratum appears in Arch Intern Med 1996;156(17):1920] Arch Intern Med. 1996;156(7):799–805
  27. Chen J, Radford MJ, Wang Y, et al. Do “America’s Best Hospitals” perform better for acute myocardial infarction?. N Engl J Med. 1999;340(4):286–292
  28. Chen J, Radford MJ, Wang Y, et al. Performance of the “100 Top Hospitals”: What does the report card report?. Health Aff. 1999;18(4):53–68
  29. Taylor DH, Whellan DJ, Sloan FA. Effects of admission to a teaching hospital on the cost and quality of care for medicare beneficiaries. New Engl J Med. 1999;340(4):293–299
  30. O’Connor GT, Quinton HB, Travern ND, et al. Geographic variation in the treatment of acute myocardial infarction. JAMA. 1999;281(7):627–633
  31. Bundorf M, Escarce J, Stafford J, et al. Impact of managed care on the treatment, costs, and outcomes of fee-for-service Medicare patients with acute myocardial infarction. Health Serv Res. 2005;39(1):131–152
  32. Radcliff T. Assessing the relationship between hospital competiton and guideline adherence for acute myocardial infarction [dissertation]. Minneapolis, MN: University of Minnesota; 2000;
  33. Sloan F, Trogdon J, Curtis LH, Schulman KA. Does the ownership of the admitting hospital make a difference? (Outcomes and process of care for Medicare beneficiaries admitted with acute myocardial infarction). Med Care. 2003;41(10):1193–1205
  34. Berger AK, Edris DW, Breall JA, et al. Resource use and quality of care for Medicare patients with acute myocardial infarction in Maryland and the District of Columbia: Analysis of data from the Cooperative Cardiovascular Project. Am Heart J. 1998;135(2 Pt 1):349–356
  35. Ellerbeck EF, Jencks SF, Radford MJ, et al. Quality of care for Medicare patients with acute myocardial infarction (A four-state pilot study from the Cooperative Cardiovascular Project). JAMA. 1995;273(19):1509–1514
  36. Kresowik T. Cooperative Cardiovascular Project: Committee updates. Iowa Med. 1993;83(10):379
  37. Grumbach K, Anderson GM, Luft HS, et al. Regionalization of cardiac surgery in the United States and Canada: Geographic access, choice, and outcomes. JAMA. 1995;274(16):1282–1288
  38. Sukel TA, Lucas FL, Wennberg DE. Long-term outcomes of regional variations in intensity of invasive vs medical management of Medicare patients with acute myocardial infarction. JAMA. 2004;293(11):1329–1337
  39. Krumholz HM, Howes CJ, Murillo JE, et al. Validation of a clinical prediction rule for left ventricular ejection fraction after myocardial infarction in patients > or = 65 years old. Am J Cardiol. 1997;80(1):11–15
  40. Krumholz HM, Chen J, Murillo JE, et al. Clinical correlates of in-hospital costs for acute myocardial infarction in patients 65 years of age and older. Am Heart J. 1998;135(3):523–531
  41. Krumholz HM, Radford MJ, Ellerbeck EF, et al. Aspirin in the treatment of acute myocardial infarction in elderly Medicare beneficiaries. Circulation. 1995;92(10):2841–2847
  42. Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966;44(1):166–203
  43. Donabedian A. The quality of care: How can it be assessed?. JAMA. 1988;260:1743–1748
  44. Bradley E, Wetle T, Horwitz D. The Patient Self-Determination Act and advance directive completion in nursing homes. Arch Fam Med. 1998;7:423
  45. Teno J, Branco K, Mor C, et al. Changes in advance care planning in nursing homes before and after the Patient Self-Determination Act: Report of a 10-state survey. J Am Geriatr Soc. 1997;45:939–944
  46. Makuc DM, Haglund B, Ingram DD, et al. Vital and Health Statistics: Health Service Areas for the United States. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, US Department of Health and Human Services; 1991;DHHS (PHS)92-1386.
  47. StataCorp. Stata Statistical Software: Release 8.0. College Station, TX: Stata Corporation; 2003;
  48. Jackson E, Yarzebski J, Goldberg R, et al. Do not resuscitate orders in patients hospitalized with acute myocardial infarction: The Worcester Heart Attack Study. Arch Intern Med. 2004;164(7):776–783
  49. Egleston BL, Rudberg MA, Brody JA. State variation in nursing home mortality outcomes according to do-not-resuscitate status. J Gerontol A Med Sci Biol Sci. 2000;55(4):M215–M220

 Data were provided by StratisHealth, the Quality Improvement Organization for Minnesota and the University of Minnesota, Twin Cities.The analyses on which this publication is based were performed under Dissertation Fellowship Grant No. 30-P-91016/5-01, entitled “Assessing the relationship between hospital competition and guideline adherence for acute myocardial infarction,” sponsored by the Centers for Medicare and Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is the direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects derived from the analysis of patterns of care, and therefore required no special funding on the part of this contractor. Feedback to the author concerning the issues presented is welcomed.None of the study’s authors have real or perceived conflicts of interest related to this research.

PII: S1525-8610(06)00336-7

doi: 10.1016/j.jamda.2006.06.004

JAMDA
Volume 8, Issue 2 , Pages 91-97 , February 2007

Article Tools