Emergency department visits and hospitalizations by tube-fed nursing home residents with varying degrees of cognitive impairment: a national study

BMC Geriatrics

Sei J Lee²  Prasanthi Govindarajan³  Nathan Sackett¹  Caroline E Stephens² 

[1] UC Berkeley/UCSF Joint Medical Program, 570 University Hall #1190, Berkeley, CA 94720, USA;Division of Geriatrics, Palliative & Extended Care, UCSF/San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA 94121, USA;Department of Emergency Medicine, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA

关键词: Ambulatory care sensitive;    Hospitalization;    Emergency department;    Nursing home;    Cognitive impairment;    Tube feeding;   

Others  :  855247
DOI  :  10.1186/1471-2318-14-35

 received in 2013-10-14, accepted in 2014-03-07,  发布年份 2014

【 摘 要 】

Background

Numerous studies indicate that the use of feeding tubes (FT) in persons with advanced cognitive impairment (CI) does not improve clinical outcomes or survival, and results in higher rates of hospitalization and emergency department (ED) visits. It is not clear, however, whether such risk varies by resident level of CI and whether these ED visits and hospitalizations are potentially preventable. The objective of this study was to determine the rates of ED visits, hospitalizations and potentially preventable ambulatory care sensitive (ACS) ED visits and ACS hospitalizations for long-stay NH residents with FTs at differing levels of CI.

Methods

We linked Centers for Medicare and Medicaid Services inpatient & outpatient administrative claims and beneficiary eligibility data with Minimum Data Set (MDS) resident assessment data for nursing home residents with feeding tubes in a 5% random sample of Medicare beneficiaries residing in US nursing facilities in 2006 (n = 3479). Severity of CI was measured using the Cognitive Performance Scale (CPS) and categorized into 4 groups: None/Mild (CPS = 0-1, MMSE = 22-25), Moderate (CPS = 2-3, MMSE = 15-19), Severe (CPS = 4-5, MMSE = 5-7) and Very Severe (CPS = 6, MMSE = 0-4). ED visits, hospitalizations, ACS ED visits and ACS hospitalizations were ascertained from inpatient and outpatient administrative claims. We estimated the risk ratio of each outcome by CI level using over-dispersed Poisson models accounting for potential confounding factors.

Results

Twenty-nine percent of our cohort was considered “comatose” and “without any discernible consciousness”, suggesting that over 20,000 NH residents in the US with feeding tubes are non-interactive. Approximately 25% of NH residents with FTs required an ED visit or hospitalization, with 44% of hospitalizations and 24% of ED visits being potentially preventable or for an ACS condition. Severity of CI had a significant effect on rates of ACS ED visits, but little effect on ACS hospitalizations.

Conclusions

ED visits and hospitalizations are common in cognitively impaired tube-fed nursing home residents and a substantial proportion of ED visits and hospitalizations are potentially preventable due to ACS conditions.

【 授权许可】

   
2014 Stephens et al.; licensee BioMed Central Ltd.

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