Correlates of a “do not hospitalize” designation

OBJECTIVE To explore what nursing home resident demographic, clinical, functional, and health services utilization characteristics influence a “do not hospitalize” designation.

DESIGN Historical cohort study.

SETTING Vancouver, BC.

PARTICIPANTS Extended care residents in 2 hospital-based and 4 free-standing nursing homes who died between 2001 and 2007.

MAIN OUTCOME MEASURES The designation of “do not hospitalize” on a resident’s chart.

RESULTS Continuity of family physician care from admission to death (adjusted hazard ratio [AHR] 2.16, 95% confidence interval [CI] 1.33 to 3.49), a sudden and unexpected death (AHR 0.43, 95% CI 0.25 to 0.73), and age (AHR 1.02, 95% CI 1.01 to 1.02) were independently associated with a “do not hospitalize” designation.

CONCLUSION The greater than 2-fold positive association of continuity of family physician care with a “do not hospitalize” designation is an interesting addition to the literature on how continuity of physician care matters.