| Predictors of emergent feeding tubes and tracheostomies in amyotrophic lateral sclerosis (ALS). | |
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MedLine Citation:
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PMID: 22533463 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Predictable decline in ALS makes unplanned gastrostomy and tracheostomy avoidable. We determined whether gastrostomy or tracheostomy insertion during emergent hospitalization is associated with patient or hospital characteristics, changed Medicare policy in 2001, or proximity to specialized ALS care. We performed a retrospective analysis of hospitalizations and procedures for ALS/MND patients in Pennsylvania between 1996 and 2009. We identified predictors of gastrostomy/tracheostomy during emergent hospitalization and trends over time. Patients underwent 1748 gastrostomies and 373 tracheostomies. Thirty-two percent of gastrostomies and 67% of tracheostomies were placed emergently. Emergent hospitalizations involving gastrostomy were more expensive with fewer home discharges. Black patients and Medicaid patients had higher odds of emergent gastrostomy placement. Conversely, academic hospital affiliation decreased odds of emergent gastrostomy or tracheostomy placement (AOR 0.49, AOR 0.37, p < 0.001). After Medicare policy changes, gastrostomy use increased, while emergent gastrostomies decreased. Surprisingly, proximity to specialized care was associated with increased emergent gastrostomy placement. In conclusion, black patients and Medicaid patients were more likely to undergo emergent gastrostomy insertion. Patients receiving gastrostomy during emergent admissions had fewer home discharges and higher costs. Academic hospital affiliation decreased odds of emergent gastrostomy or tracheostomy. After Medicare changes broadening access, while gastrostomy use increased, the proportion of emergent procedures decreased. |
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Authors:
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Amy Y Tsou; Jason Karlawish; Leo McCluskey; Sharon X Xie; Judith A Long |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Amyotrophic lateral sclerosis : official publication of the World Federation of Neurology Research Group on Motor Neuron Diseases Volume: 13 ISSN: 1471-180X ISO Abbreviation: Amyotroph Lateral Scler Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-04-26 Completed Date: 2012-08-31 Revised Date: 2013-04-09 |
Medline Journal Info:
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Nlm Unique ID: 101283386 Medline TA: Amyotroph Lateral Scler Country: England |
Other Details:
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Languages: eng Pagination: 318-25 Citation Subset: IM |
Affiliation:
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Robert Wood Johnson Foundation Veterans Affairs Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA. amy.tsou@uphs.upenn.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Amyotrophic Lateral Sclerosis / economics, therapy* Enteral Nutrition* Female Gastrostomy Health Policy Hospitalization / economics Humans Male Medicare / economics Middle Aged Outcome and Process Assessment (Health Care) Pennsylvania Retrospective Studies Tracheostomy* / economics United States |
| Grant Support | |
ID/Acronym/Agency:
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P30 AG010124/AG/NIA NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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