Churning: The Association between Health Care Transitions and Feeding Tube Insertion for Nursing Home Residents with Advanced Cognitive Impairment
Churning: The Association between Health Care Transitions and Feeding Tube Insertion for Nursing Home Residents with Advanced Cognitive Impairment
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DOI：
10.1089/jpm.2008.0168
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发表时间：
2009-04-01
影响因子：
2.8
通讯作者：
Mor, Vincent
中科院分区：
文献类型：
--
作者：
Teno, Joan M.;Mitchell, Susan L.;Mor, Vincent
背景：在美国各州，老年疗养院居民（NHR）中有晚期认知障碍的饲管使用率有十倍的差异。本研究的目的是检查在生命末期医疗保健转换率较高的地区是否更有可能在严重认知障碍患者中使用饲管。方法：对美国老年护理之家的晚期认知障碍患者进行回顾性队列研究。喂食管插入的发生率由医疗保险A部分和B部分账单数据确定。对疗养院居民在生命的最后6个月内进行医疗保健转换的次数进行了统计。一个多变量模型检验了居住在具有较高医疗保健转换率的地理区域与使用高级认知障碍的家庭居民插入饲管的关系。结果：医院转诊地区（HRR）在生命的最后6个月内，每100名死者中有192人（俄勒冈州塞勒姆）到509人（路易斯安那州门罗）。转换率越高的HRRs，其置管发生率越高（Spearman相关系数= 0.58）。居住在过渡率最高五分位数地区的受试者插入饲管的可能性是居住在最低五分位数地区的受试者的2.5倍（95%可信区间[CI] 1.9-3.2）。结论：在养老院居民中护理转换率较高的地区，对于严重认知障碍的患者，也更有可能有较高的喂食管放置率，这是一个不太可能受益的人群。
Background: There is a tenfold variation across U. S. states in the prevalence of feeding tube use among elderly nursing home residents (NHR) with advanced cognitive impairment. The goal of this study was to examine whether regions with higher rates of health care transitions at the end of life are more likely to use feeding tubes in patients with severe cognitive impairment.Methods: A retrospective cohort study of U. S. nursing home residents with advanced cognitive impairment. The incidence of feeding tube insertion was determined by Medicare Part A and B billing data. A count of the number of health care transition in the last 6 months of life was determined for nursing home residents. A multivariate model examined the association of residing in a geographic region with a higher rates of health care transition and the insertion of a feeding tube in nusing home resident with advance cognitive impairment.Results: Hospital Referral Region (HRR) health care transitions varied from 192 (Salem, Oregon) to 509 per 100 decedents (Monroe, Louisiana) within the last 6 months of life. HRRs with higher transition rates had a higher incidence of feeding tube insertion (Spearman correlation = 0.58). Subjects residing in regions with the highest quintile of transitions rates were 2.5 times (95% confidence interval [CI] 1.9-3.2) more likely to have a feeding tube inserted compared to those that resided in the lowest quintile.Conclusions: Regions with higher rates of care transitions among nursing home residents are also much more likely to have higher rates of feeding tube placement for patients with severe cognitive impairment, a population in whom benefit is unlikely.