title: Regional Comparison of Enteral Nutrition-Related Admission Policies in Skilled Nursing Facilities.
abstract: BACKGROUND
  Nursing home admission policies are one driver of increased and earlier gastrostomy placement, a procedure that is not always medically or ethically indicated among patients needing short-term nutrition support. This important clinical decision should be based upon patient prognosis, goals, and needs. We compared nursing home enteral nutrition-related admission policies in New York City and other regions of the United States. We also explored motivations for these policies.
  
  
  METHODS
  We conducted a telephone survey with skilled nursing facility administrators in New York City and a random sample of facilities throughout the United States about enteral nutrition-related admission policies. Survey data were matched with publically available data about facility characteristics from the Centers for Medicare and Medicaid Services. The relationship between facility location and admission policies was described with regression models. Reasons for these policies were thematically analyzed.
  
  
  RESULTS
  New York City nursing homes were significantly less likely to admit patients with nasogastric feeding tubes than were nursing homes nationwide, after we controlled for facility characteristics (odds ratio = 0.111; 95% CI, 0.032-0.344). Reasons for refusing nasogastric tubes fell into 5 categories: safety, capacity, policy, perception of appropriate level of care, and patient quality of life.
  
  
  CONCLUSIONS
  Our findings indicate that enteral nutrition-related admission policies vary greatly between nursing homes in New York City and nationwide. Many administrators cited safety and policy as factors guiding their institutional policies and practices, despite a lack of evidence. This gap in research, practice, and policy has implications for quality and cost of care, length of hospital stay, and patient morbidity and mortality.
authors.affiliation: Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, New York, New York.
authors.forename: Marissa
authors.initials: M
authors.lastname: Burgermaster
authors.affiliation: Department of Gastroenterology, Galway University Hospitals, Gallimh, Ireland.
authors.forename: Eoin
authors.initials: E
authors.lastname: Slattery
authors.affiliation: Center for World Health, University of California, Los Angeles, California.
authors.forename: Nafeesa
authors.initials: N
authors.lastname: Islam
authors.affiliation: Arts and Sciences, Rutgers University, Newark, New Jersey.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Ippolito
authors.affiliation: Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, New York, New York Institute of Human Nutrition, Columbia University Medical Center, New York, New York dss2135@cumc.columbia.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Seres
mesh_terms: D003430:Cross-Sectional Studies; D004750:Enteral Nutrition / Q000379:methods* / Q000706:statistics & numerical data*; D005774:Gastrostomy / Q000706:statistics & numerical data; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D009519:New York City; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D014481:United States
keywords: enteral nutrition; gastrostomy; medical ethics; nasogastric feeding; nursing homes