Rashmi K Sharma1, Hyosin Kim2, Pedro L Gozalo3,4, Donald R Sullivan5,6, Jennifer Bunker2, Joan M Teno2. 1. Division of General Internal Medicine, University of Washington, Seattle, Washington, USA. 2. Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, Oregon, USA. 3. Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA. 4. Providence Veterans Administration Medical Center, Center of Innovation in Health Services Research and Development Service, Providence, Rhode Island, USA. 5. Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA. 6. Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon, USA.
Abstract
BACKGROUND/ OBJECTIVES: Over the past decade, feeding tube use in nursing home residents with advanced dementia has declined by 50% among white and black patients. Little is known about whether a similar reduction has occurred in other invasive interventions, such as mechanical ventilation. DESIGN: Retrospective cohort study. SETTING: Acute-care hospitals in the United States. PARTICIPANTS: Medicare beneficiaries with advanced dementia who previously resided in a nursing home and were hospitalized between 2001 and 2014 with pneumonia and/or septicemia and of either black or white race. MEASUREMENT: Invasive mechanical ventilation (IMV), as identified by International Classification of Diseases (ICD) procedure codes. Two multivariable logistic regression models examined the association between race and the likelihood of receiving IMV, adjusting for patients' demographics, physical function, and comorbidities. A hospital fixed-effects model examined the association of race within a hospital, whereas a random-effects logistic model was used to estimate the between-hospital variation in the probability of receiving IMV and examine the overall association of race and use of IMV. RESULTS: Between 2001 and 2014, 289,017 patients with advanced dementia were hospitalized for pneumonia or septicemia. Use of IMV increased from 3.7% to 12.1% in white patients and from 8.6% to 21.8% in blacks. Among those ventilated, 1-year mortality rates remained high, at 82.7% for whites and 84.2% for blacks dying in 2013. Compared with whites, blacks had a higher odds of receiving IMV in the fixed-effects (within-hospital) model (adjusted odds ratio (AOR) = 1.34; 95% confidence interval (CI) = 1.29-1.39) and in the random-effects (between-hospital) model (AOR = 1.46; 95% CI = 1.40-1.51). CONCLUSION: IMV use in patients with advanced dementia has increased substantially, with black patients having a larger increase than whites, based, in part, on the hospitals where black patients receive care.
BACKGROUND/ OBJECTIVES: Over the past decade, feeding tube use in nursing home residents with advanced dementia has declined by 50% among white and black patients. Little is known about whether a similar reduction has occurred in other invasive interventions, such as mechanical ventilation. DESIGN: Retrospective cohort study. SETTING: Acute-care hospitals in the United States. PARTICIPANTS: Medicare beneficiaries with advanced dementia who previously resided in a nursing home and were hospitalized between 2001 and 2014 with pneumonia and/or septicemia and of either black or white race. MEASUREMENT: Invasive mechanical ventilation (IMV), as identified by International Classification of Diseases (ICD) procedure codes. Two multivariable logistic regression models examined the association between race and the likelihood of receiving IMV, adjusting for patients' demographics, physical function, and comorbidities. A hospital fixed-effects model examined the association of race within a hospital, whereas a random-effects logistic model was used to estimate the between-hospital variation in the probability of receiving IMV and examine the overall association of race and use of IMV. RESULTS: Between 2001 and 2014, 289,017 patients with advanced dementia were hospitalized for pneumonia or septicemia. Use of IMV increased from 3.7% to 12.1% in white patients and from 8.6% to 21.8% in blacks. Among those ventilated, 1-year mortality rates remained high, at 82.7% for whites and 84.2% for blacks dying in 2013. Compared with whites, blacks had a higher odds of receiving IMV in the fixed-effects (within-hospital) model (adjusted odds ratio (AOR) = 1.34; 95% confidence interval (CI) = 1.29-1.39) and in the random-effects (between-hospital) model (AOR = 1.46; 95% CI = 1.40-1.51). CONCLUSION:IMV use in patients with advanced dementia has increased substantially, with black patients having a larger increase than whites, based, in part, on the hospitals where black patients receive care.
Authors: Amber E Barnato; Denise L Anthony; Jonathan Skinner; Patricia M Gallagher; Elliott S Fisher Journal: J Gen Intern Med Date: 2009-04-23 Impact factor: 5.128
Authors: M E Merchán-Tahvanainen; C Romero-Belmonte; M Cundín-Laguna; P Basterra-Brun; A San Miguel-Aguirre; E Regaira-Martínez Journal: Enferm Intensiva Date: 2017-01-26
Authors: Cristiana Z Borjaille; Andrea D Hill; Ruxandra Pinto; Robert A Fowler; Damon C Scales; Hannah Wunsch Journal: Anesth Analg Date: 2019-10 Impact factor: 5.108
Authors: Angelo E Volandes; Michael Paasche-Orlow; Muriel R Gillick; E F Cook; Shimon Shaykevich; Elmer D Abbo; Lisa Lehmann Journal: J Palliat Med Date: 2008-06 Impact factor: 2.947
Authors: Romana Hasnain-Wynia; David W Baker; David Nerenz; Joe Feinglass; Anne C Beal; Mary Beth Landrum; Raj Behal; Joel S Weissman Journal: Arch Intern Med Date: 2007-06-25
Authors: Joan M Teno; Pedro Gozalo; Nita Khandelwal; J Randall Curtis; David Meltzer; Ruth Engelberg; Vincent Mor Journal: JAMA Intern Med Date: 2016-12-01 Impact factor: 21.873
Authors: Rashmi K Sharma; Andrew Teng; Mary Grace Asirot; Jean O Taylor; Soo Borson; Anne M Turner Journal: J Am Geriatr Soc Date: 2022-03-21 Impact factor: 7.538