Regional Comparison of Enteral Nutrition–Related Admission Policies in Skilled Nursing Facilities
| Autor: | Marissa Burgermaster, Paul R. Ippolito, David S. Seres, Nafeesa Islam, Eoin Slattery |
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| Rok vydání: | 2016 |
| Předmět: |
nasogastric feeding
complications Medicine (miscellaneous) home residents nursing homes Skilled Nursing peg percutaneous endoscopic gastrostomy Article advanced cognitive impairment 03 medical and health sciences 0302 clinical medicine Nursing Humans enteral nutrition Medicine 030212 general & internal medicine intensive-care-unit feeding-tube use Skilled Nursing Facilities Nutrition and Dietetics business.industry placement United States Facility location problem Telephone survey Cross-Sectional Studies Parenteral nutrition medical ethics Health Care Surveys advanced dementia gastrostomy Nutrition support Survey data collection New York City 030211 gastroenterology & hepatology Skilled Nursing Facility business Medicaid in-hospital mortality |
| Zdroj: | Nutrition in Clinical Practice. 31:342-348 |
| ISSN: | 1941-2452 0884-5336 |
| DOI: | 10.1177/0884533616629636 |
| Popis: | Background: Nursing home admission policies are one driver of increased and earlier gastrostomy placement, a procedure that is not always medically or ethically indicated among patients needing short-term nutrition support. This important clinical decision should be based upon patient prognosis, goals, and needs. We compared nursing home enteral nutrition-related admission policies in New York City and other regions of the United States. We also explored motivations for these policies. Methods: We conducted a telephone survey with skilled nursing facility administrators in New York City and a random sample of facilities throughout the United States about enteral nutrition-related admission policies. Survey data were matched with publically available data about facility characteristics from the Centers for Medicare and Medicaid Services. The relationship between facility location and admission policies was described with regression models. Reasons for these policies were thematically analyzed. Results: New York City nursing homes were significantly less likely to admit patients with nasogastric feeding tubes than were nursing homes nationwide, after we controlled for facility characteristics (odds ratio = 0.111; 95% CI, 0.032-0.344). Reasons for refusing nasogastric tubes fell into 5 categories: safety, capacity, policy, perception of appropriate level of care, and patient quality of life. Conclusion: Our findings indicate that enteral nutrition-related admission policies vary greatly between nursing homes in New York City and nationwide. Many administrators cited safety and policy as factors guiding their institutional policies and practices, despite a lack of evidence. This gap in research, practice, and policy has implications for quality and cost of care, length of hospital stay, and patient morbidity and mortality. |
| Databáze: | OpenAIRE |
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