Mitchell Susan L, Buchanan Joan L, Littlehale Steven, Hamel Mary Beth
Hebrew Rehabilitation Center for Aged Research and Training Institute, Department of Medicine of Beth Israel Deaconess Medical Center, Division on Aging, Harvard Medical School, Boston, MA 02131, USA.
J Am Med Dir Assoc. 2004 Mar-Apr;5(2 Suppl):S22-9. doi: 10.1097/01.JAM.0000043421.46230.0E.
To compare the costs associated with caring for severely demented residents nursing homes with and without feeding tubes.
Retrospective cohort study.
A 700-bed long-term care facility in Boston.
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.
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.
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.
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.
比较为有或没有鼻饲管的重度痴呆养老院居民提供护理的相关成本。
回顾性队列研究。
波士顿一家拥有700张床位的长期护理机构。
65岁及以上患有晚期痴呆且存在进食问题、已将长期鼻饲管作为一种治疗选择进行讨论的养老院居民。
对做出鼻饲决定后的6个月内接受或未接受鼻饲管安置的居民，就以下项目比较成本：护理时间、医生评估、食物、住院、急诊就诊、诊断检查、抗生素治疗和胃肠外补液以及鼻饲管插入。
纳入22名受试者，11名接受鼻饲（平均年龄84.3岁±6.0岁），11名接受人工喂食（平均年龄90.2岁±9.1岁）。没有鼻饲管的居民养老院护理每日成本高于有鼻饲管的居民（4219美元±1546美元对2379美元±1032美元，P = 0.006）。尽管如此，在至少26个州，医疗补助计划对接受鼻饲的痴呆居民的养老院报销高于对有类似缺陷但未接受鼻饲的居民。通常向医疗保险收费的成本，接受鼻饲的患者更高（6994美元±5790美元对959美元±591美元，P < 0.001），主要是因为与初始鼻饲管安置以及因鼻饲并发症管理而住院或急诊就诊相关的高成本。
养老院面临对晚期痴呆居民进行鼻饲的潜在财政激励：接受鼻饲的居民从医疗补助计划获得更高的每日报销率，但所需的养老院护理成本更低。从医疗保险的角度来看，接受鼻饲的患者成本高昂，因为与鼻饲管安置和并发症的急性处理相关的成本很高。需要进一步开展工作以确定这些潜在的经济激励措施在实际中是否会影响鼻饲决策。
