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Fig 1.

Directed acyclic graph depicting hypothesized relationships.

Abbreviations: DNR/I, Do Not Resuscitate and/or Intubate; EMR, Electronic Medical Record.

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Table 1.

Adult patients with an active DNR or DNI order in the EMR at the time of discharge from Johns Hopkins Hospital between July 2013 and January 2015.

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Fig 2.

Study flow diagram.

Abbreviations: DNR/I = Do Not Resuscitate and/or Intubate; JHH = Johns Hopkins Hospital; MOLST = Maryland Medical Orders for Life Sustaining Treatment.

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Table 2.

Patient characteristics stratified by MOLST form at readmission.

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Table 3.

Treatment and outcomes by presence of a MOLST form at readmission.

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Fig 3.

Probability of remaining “full code” (i.e. without a Do Not Resuscitate (DNR) or Do Not Intubate (DNI) order) during the first 72 hours after readmission to Johns Hopkins Hospital within 30 days of index hospitalization.

All patients had an active DNR or DNI order at discharge from the index hospitalization. Hatch marks indicate patients censored from analysis by hospital discharge. No patient died prior to an order limiting life support or hospital discharge. Kaplan-Meier estimates of time to first DNR/DNI order during readmission were compared using the stratified log-rank test. (Panel A) The subset of 112 patients for whom hospital admission screening questions were answered by the patient or their proxy. (B) The subset of 12 patients who were not able to communicate and did not have a proxy present at the time of hospital readmission. Abbreviations: MOLST = Maryland Medical Orders for Life Sustaining Treatment.

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