Program in Public Health, Department of Health Services, Policy & Practice, Brown University, Providence, RI 02912, USA.
J Pain Symptom Manage. 2013 Mar;45(3):524-33. doi: 10.1016/j.jpainsymman.2012.02.007. Epub 2012 Aug 4.
Research is conflicting on whether receiving medical care at a hospital with more aggressive treatment patterns improves survival.
The aim of this study was to examine whether nursing home residents admitted to hospitals with more aggressive patterns of feeding tube insertion had improved survival.
Using the 1999-2007 Minimum Data Set matched to Medicare claims, we identified hospitalized nursing home residents with advanced cognitive impairment who did not have a feeding tube inserted prior to their hospital admissions. The sample included 56,824 nursing home residents and 1773 acute care hospitals nationwide. Hospitals were categorized into nine groups based on feeding tube insertion rates and whether the rates were increasing, staying the same, or decreasing between the periods of 2000-2003 and 2004-2007. Multivariate logit models were used to examine the association between the hospital patterns of feeding tube insertion and survival among hospitalized nursing home residents with advanced cognitive impairment.
Nearly one in five hospitals (N=366) had persistently high rates of feeding tube insertion. Being admitted to these hospitals with persistently high rates of feeding tube insertion was not associated with improved survival when compared with being admitted to hospitals with persistently low rates of feeding tube insertion. The adjusted odds ratios were 0.93 (95% confidence interval [CI]: 0.87, 1.01) and 1.02 (95% CI: 0.95, 1.09) for one-month and six-month posthospitalization survival, respectively.
Hospitals with more aggressive patterns of feeding tube insertion did not have improved survival for hospitalized nursing home residents with advanced cognitive impairment.
研究结果对在治疗模式更激进的医院接受治疗是否能提高生存率存在争议。
本研究旨在检验入住治疗模式更激进的医院的养老院居民的生存率是否有所提高。
利用 1999-2007 年最低数据组与医疗保险索赔相匹配，我们确定了患有严重认知障碍且在入院前未插入饲管的住院养老院居民。该样本包括全国范围内 56824 名养老院居民和 1773 家急性护理医院。根据饲管插入率以及这些率在 2000-2003 年和 2004-2007 年期间是增加、保持不变还是减少，将医院分为 9 组。采用多变量逻辑回归模型检验在严重认知障碍的住院养老院居民中，医院饲管插入模式与生存之间的关联。
近五分之一的医院（N=366）饲管插入率持续较高。与饲管插入率持续较低的医院相比，入住这些饲管插入率持续较高的医院与生存率提高无关。调整后的比值比分别为 0.93（95%置信区间[CI]：0.87，1.01）和 1.02（95%CI：0.95，1.09），用于评估一个月和六个月的住院后生存率。
对于患有严重认知障碍的住院养老院居民，治疗模式激进的医院并未提高生存率。
