title: Do patients with advanced cognitive impairment admitted to hospitals with higher rates of feeding tube insertion have improved survival?
abstract: BACKGROUND
  Research is conflicting on whether receiving medical care at a hospital with more aggressive treatment patterns improves survival.
  
  
  OBJECTIVE
  The aim of this study was to examine whether nursing home residents admitted to hospitals with more aggressive patterns of feeding tube insertion had improved survival.
  
  
  METHODS
  Using the 1999-2007 Minimum Data Set matched to Medicare claims, we identified hospitalized nursing home residents with advanced cognitive impairment who did not have a feeding tube inserted prior to their hospital admissions. The sample included 56,824 nursing home residents and 1773 acute care hospitals nationwide. Hospitals were categorized into nine groups based on feeding tube insertion rates and whether the rates were increasing, staying the same, or decreasing between the periods of 2000-2003 and 2004-2007. Multivariate logit models were used to examine the association between the hospital patterns of feeding tube insertion and survival among hospitalized nursing home residents with advanced cognitive impairment.
  
  
  RESULTS
  Nearly one in five hospitals (N=366) had persistently high rates of feeding tube insertion. Being admitted to these hospitals with persistently high rates of feeding tube insertion was not associated with improved survival when compared with being admitted to hospitals with persistently low rates of feeding tube insertion. The adjusted odds ratios were 0.93 (95% confidence interval [CI]: 0.87, 1.01) and 1.02 (95% CI: 0.95, 1.09) for one-month and six-month posthospitalization survival, respectively.
  
  
  CONCLUSIONS
  Hospitals with more aggressive patterns of feeding tube insertion did not have improved survival for hospitalized nursing home residents with advanced cognitive impairment.
authors.affiliation: Program in Public Health, Department of Health Services, Policy & Practice, Brown University, Providence, RI 02912, USA. Shubing_Cai@brown.edu
authors.forename: Shubing
authors.initials: S
authors.lastname: Cai
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Gozalo
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
authors.forename: Sylvia
authors.initials: S
authors.lastname: Kuo
authors.forename: Julie P W
authors.initials: JP
authors.lastname: Bynum
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.forename: Joan M
authors.initials: JM
authors.lastname: Teno
mesh_terms: D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000401:mortality* / Q000451:nursing*; D004750:Enteral Nutrition; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D009732:Nursing Care / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology