Teno Joan, Meltzer David O, Mitchell Susan L, Fulton Ana T, Gozalo Pedro, Mor Vincent
Health Aff (Millwood). 2014 Apr;33(4):675-82. doi: 10.1377/hlthaff.2013.1248.
Striking variation has been documented in the rates of feeding tube insertion for hospitalized patients with advanced dementia. This occurs despite the harms of the procedure, which may outweigh its benefits, and the procedure's inconsistency with care focused on the patient's comfort. Among nursing home residents with advanced dementia who were hospitalized in 2001-10 with an infection or dehydration, we found that rates of insertion of a percutaneous endoscopic gastrostomy feeding tube varied by type of attending physician. Insertion rates were markedly lower when all of a patient's attending physicians were hospitalists (1.6 percent) or nonhospitalist generalists (2.2 percent), compared to all subspecialists (11.0 percent) or a mixture of physicians by type, which typically included a subspecialist (15.6 percent). The portion of patients seen by a mixture of attending physicians increased from 28.9 percent in 2001 to 38.3 percent in 2010. Efforts to improve decision making in the care of patients with advanced dementia should include interventions to improve communication among physicians and the education of subspecialists about the merits of using feeding tubes with this population.
已记录到，晚期痴呆症住院患者的饲管插入率存在显著差异。尽管该操作存在危害，其危害可能超过益处，且该操作与注重患者舒适度的护理不一致，但这种差异依然存在。在2001年至2010年因感染或脱水而住院的晚期痴呆症疗养院居民中，我们发现经皮内镜下胃造口饲管的插入率因主治医生类型而异。当患者的所有主治医生均为住院医师（1.6%）或非住院专科全科医生（2.2%）时，插入率明显低于所有专科医生（11.0%）或不同类型医生的组合（通常包括一名专科医生，15.6%）。由不同主治医生组合诊治的患者比例从2001年的28.9%增至2010年的38.3%。改善晚期痴呆症患者护理决策的努力应包括改善医生之间沟通的干预措施，以及对专科医生进行关于对这类患者使用饲管益处的教育。
