The use of do-not-hospitalize orders by family physicians in Ohio

A sample of Ohio family physicians was surveyed by mail questionnaire regarding physician attitudes and practices concerning do-not-hospitalize (DNH) orders. One hundred seventy-three of the 210 physicians who completed the survey provided care for patients in nursing homes. Fifty-eight percent of physicians caring for nursing home patients were familiar with the concept of do not hospitalize, and 42% had utilized a DNH order. The most commonly named reasons for using a DNH order were patient's terminal condition and patient's request. The most common reasons physicians did not use a DNH order were because of family objections and the inability of nursing homes to deliver intravenous antibiotics and fluids. Almost all physicians had encountered a clinical situation where a DNH order might be appropriate, and 73% of physicians familiar with the DNH concept had utilized the order. Familiarizing more physicians with the concept of DNH orders may have great potential for reducing health care costs and preserving patient autonomy. Future studies are needed to validate the concept of do not hospitalize.