Document Detail


Predictors of emergent feeding tubes and tracheostomies in amyotrophic lateral sclerosis (ALS).
MedLine Citation:
PMID:  22533463     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Amy Y Tsou; Jason Karlawish; Leo McCluskey; Sharon X Xie; Judith A Long
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Publication Detail:
Type:  Journal Article    
Journal Detail:
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:
Created Date:  2012-04-26     Completed Date:  2012-08-31     Revised Date:  2014-07-21    
Medline Journal Info:
Nlm Unique ID:  101283386     Medline TA:  Amyotroph Lateral Scler     Country:  England    
Other Details:
Languages:  eng     Pagination:  318-25     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
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:
P01 AG032953/AG/NIA NIH HHS; P30 AG010124/AG/NIA NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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