Tube-feeding versus hand-feeding nursing home residents with advanced dementia: a cost comparison.
Tube-feeding versus hand-feeding nursing home residents with advanced dementia: a cost comparison.
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患有晚期痴呆症的疗养院居民的管饲与手工喂养：成本比较。
DOI：
10.1097/01.jam.0000043421.46230.0e
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发表时间：
2003
影响因子：
7.6
通讯作者：
Hamel,MaryBeth
中科院分区：
文献类型：
--
作者：
Mitchell,SusanL;Buchanan,JoanL;Littlehale,Steven;Hamel,MaryBeth
目的：比较护理严重痴呆居民的护理院有和没有喂养管的相关费用。设计：回顾性队列研究。环境：波士顿一家700张床位的长期护理机构参与者：65岁及以上患有晚期痴呆症和饮食问题的疗养院居民，长期喂食管已被讨论为一种治疗选择。测量值：比较了在决定管饲后的6个月内，那些接受和未接受喂养管放置的居民的以下项目的成本：护理时间，医生评估，食物，住院，急诊室就诊，诊断测试，抗生素治疗和肠外水合作用，以及喂养管插入。结果：22例受试者入选，11例为管饲（平均年龄84.3 ± 6.0岁），11例为手饲（平均年龄90.2 ± 9.1岁）。无饲管组每日护理费用高于有饲管组（4219 ± 1546美元vs 2379 ± 1032美元，P = 0.006）。尽管如此，在至少26个州，医疗补助计划对养老院的补偿，对于管饲的痴呆症居民来说，高于没有管饲的类似赤字的居民。管饲患者通常向医疗保险收取的费用更高（6994 ± 5790美元对959 ± 591美元，P < 0.001），主要是因为最初放置喂养管和住院或急诊室治疗管饲并发症的费用较高。结论：养老院面临着一个潜在的财政激励措施，以管喂居民与先进的痴呆症：管喂居民产生更高的每日报销率从医疗补助，但需要较便宜的养老院护理。从医疗保险的角度来看，管饲病人是昂贵的，因为与喂食管放置和并发症的急性管理相关的成本很高。需要进一步的工作，以确定这些潜在的财政激励措施是否会影响管饲决策在实践中。
OBJECTIVE: To compare the costs associated with caring for severely demented residents nursing homes with and without feeding tubes. DESIGN: Retrospective cohort study. SETTING: A 700-bed long-term care facility in Boston PARTICIPANTS: Nursing home residents aged 65 years and over with advanced dementia and eating problems for whom long-term feeding tube had been discussed as a treatment option. MEASUREMENTS: Costs were compared over the 6 months that followed the tube-feeding decision for those residents who did and did not undergo feeding tube placement for the following items: nursing time, physician assessments, food, hospitalizations, emergency room visits, diagnostic tests, treatment with antibiotics and parenteral hydration, and feeding tube insertion. RESULTS: Twenty-two subjects were included, 11 were tube-fed (mean age 84.3 years ± 6.0) and 11 were hand-fed (mean age 90.2 years ± 9.1). The daily costs of nursing home care were higher for the residents without feeding tubes compared with residents with tubes ($4219 ± 1546 vs $2379 ± 1032, P = 0.006). Nonetheless, Medicaid reimbursement to nursing homes in at least 26 states is higher for demented residents who are tube-fed than for residents with similar deficits who are not tube-fed. Costs typically billed to Medicare were greater for the tube-fed patients ($6994 ± 5790 vs. $959 ± 591, P < 0.001), primarily because of the high costs associated with initial feeding tube placement and hospitalizations or emergency rooms visits for the management of complications of tube-feeding. CONCLUSIONS: Nursing homes are faced with a potential fiscal incentive to tube-feed residents with advanced dementia: tube-fed residents generate a higher daily reimbursement rate from Medicaid, yet require less expensive nursing home care. From a Medicare perspective, tube-fed patients are expensive due to the high costs associated with feeding tube placement and acute management of complications. Further work is needed to determine whether these potential financial incentives influence tube-feeding decisions in practice.