Hendricksen Meghan, Mitchell Susan L, Lopez Ruth Palan, Mazor Kathleen M, McCarthy Ellen P
Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Am Med Dir Assoc. 2022 Aug;23(8):1367-1374. doi: 10.1016/j.jamda.2021.10.015. Epub 2021 Nov 23.
Intensity of care, such as hospital transfers and tube feeding of residents with advanced dementia varies by nursing home (NH) within and across regions. Little work has been done to understand how these 2 levels of influence relate. This study's objectives are to identify facility factors associated with NHs providing high-intensity care to residents with advanced dementia and determine whether these factors differ within and across hospital referral regions (HRRs).
Cross-sectional analysis.
1449 NHs.
Nationwide 2016-2017 Minimum Data Set was used to categorize NHs and HRRs into 4 levels of care intensity based on rates of hospital transfers and tube feeding among residents with advanced dementia: low-intensity NH in a low-intensity HRR, high-intensity NH in a low-intensity HRR, low-intensity NH in a high-intensity HRR, and a high-intensity NH in a high-intensity HRR.
In high-intensity HRRs, high-vs low-intensity NHs were more likely to be urban, lack a dementia unit, have a nurse practitioner or physician (NP or PA) on staff, and have a higher proportion of residents who were male, aged <65 years, Black, had pressure ulcers, and shorter hospice stays. In low-intensity HRRs, higher proportion of Black residents was the only characteristic associated with being a high-intensity NH.
These findings suggest that within high-intensity HRRs, there are potentially modifiable factors that could be targeted to reduce burdensome care in advanced dementia, including having a dementia unit, palliative care training for NPs and PAs, and increased use of hospice care.
对于晚期痴呆症患者的护理强度，如医院转诊和鼻饲情况，在各地区内部以及不同地区之间的养老院（NH）中存在差异。目前对于这两种影响水平之间的关系了解甚少。本研究的目的是确定与养老院为晚期痴呆症患者提供高强度护理相关的机构因素，并确定这些因素在医院转诊区域（HRR）内部和不同区域之间是否存在差异。
横断面分析。
1449家养老院。
使用2016 - 2017年全国最低数据集，根据晚期痴呆症患者的医院转诊率和鼻饲率，将养老院和医院转诊区域分为4个护理强度级别：低强度医院转诊区域中的低强度养老院、低强度医院转诊区域中的高强度养老院、高强度医院转诊区域中的低强度养老院以及高强度医院转诊区域中的高强度养老院。
在高强度医院转诊区域，高强度养老院与低强度养老院相比，更有可能位于城市、没有痴呆症护理单元、有执业护士或医生（NP或PA）在职，并且男性居民、年龄小于65岁的居民、黑人居民、有压疮的居民以及临终关怀住院时间较短的居民比例更高。在低强度医院转诊区域，黑人居民比例较高是与成为高强度养老院相关的唯一特征。
这些发现表明，在高强度医院转诊区域内，存在一些可能可改变的因素，可针对这些因素来减轻晚期痴呆症患者的繁重护理负担，包括设立痴呆症护理单元、对执业护士和医生进行姑息治疗培训以及增加临终关怀护理的使用。
