State practice variations in the use of tube feeding for nursing home residents with severe cognitive impairment.
OBJECTIVE
To describe the differences in prevalence of tube feeding among states and to examine possible factors that could explain practice patterns.


METHODS
Analysis of random samples from an interstate data bank comprised of the Minimum Data Set (MDS), a standardized, federally mandated assessment instrument for nursing home residents.


METHODS
Nursing homes in four states participating in a federal demonstration project of case mix payment plus five others with existing MDS data systems.


METHODS
Individuals 65 years of age and older (N = 57,029), who had very severe cognitive impairment, including total dependence in eating, and who resided in nursing homes during 1994, the most recent year for which uniform data were available.


METHODS
State-by-state differences in prevalence of tube feeding, controlling for demographic and clinical variables.


RESULTS
The prevalence of tube feeding ranged from 7.5% in Maine to 40.1% in Mississippi. Each state had a significantly elevated prevalence of tube feeding compared with Maine, with odds ratios (ORs) ranging from 1.50 to 5.83, P < .001. Specific directives not to provide tube feeding (OR 0.41, P < .001), and white race (OR 0.45, P < .001) were strongly and negatively associated with tube feeding.


CONCLUSIONS
Wide regional variations exist in the use of tube feeding of nursing home residents with equivalent impairments. Sociodemographic factors could be important, but more study is needed to determine whether physician characteristics, such as race, attitudes, or knowledge, have an impact and to clarify medical standards for the use of tube feeding in this population.
Ahronheim
J C
JC
Department of Medicine, Saint Vincent's Hospital and Medical Center, New York, and New York Medical College, Valhalla 10011, USA.
Mulvihill
M
M
Sieger
C
C
Park
P
P
Fries
B E
BE
D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000145:classification / Q000628:therapy*; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D044469:Racial Groups; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States