title: Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds.
abstract: OBJECTIVE
  Mechanical ventilation may be lifesaving, but in certain persons, such as those with advanced dementia, it may prolong patient suffering without a clear survival benefit.
  
  
  OBJECTIVE
  To describe the use and outcomes of mechanical ventilation and its association with the increasing numbers of intensive care unit (ICU) beds in the United States for patients with advanced dementia residing in a nursing home 120 days before that hospital admission.
  
  
  METHODS
  This retrospective cohort study evaluated Medicare beneficiaries with advanced dementia hospitalized from January 1, 2000, to December 31, 2013, using the Minimum Data Set assessments linked with Medicare part A claims. A hospital fixed-effect, multivariable logistic regression model examined the effect of changes in ICU beds within individual hospitals and the likelihood of receiving mechanical ventilation, controlling for patients' demographic characteristics, function, and comorbidities.
  
  
  METHODS
  Mechanical ventilation.
  
  
  RESULTS
  From 2000 to 2013, a total of 635 008 hospitalizations of 380 060 eligible patients occurred (30.5% male and 69.5% female; mean [SD] age, 84.4 [7.4] years). Use of mechanical ventilation increased from 39 per 1000 hospitalizations in 2000 to 78 per 1000 hospitalizations in 2013 (P < .001, test of linear trend). As the number of ICU beds in a hospital increased over time, patients with advanced dementia were more likely to receive mechanical ventilation (ie, adjusted odds ratio per 10 ICU bed increase, 1.06; 95% CI, 1.05-1.07). In 2013, hospitals in the top decile in the number of ICU beds were reimbursed $9611.89 per hospitalization compared with $8050.24 per hospitalization in the lower decile (P < .001) without an improvement in 1-year mortality (65.2% vs 64.6%; P = 54).
  
  
  CONCLUSIONS
  Among hospitalized nursing home residents with advanced dementia, we found an increase in the use of mechanical ventilation over time without substantial improvement in survival. This increase in the use of mechanical ventilation was associated with an increase in the number of ICU beds within a hospital.
authors.affiliation: Department of Gerontology and Geriatrics, University of Washington, Seattle2Cambia Palliative Care Center of Excellence, University of Washington Medicine, Seattle.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Teno
authors.affiliation: Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island.
authors.forename: Pedro
authors.initials: P
authors.lastname: Gozalo
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle.
authors.forename: Nita
authors.initials: N
authors.lastname: Khandelwal
authors.affiliation: Cambia Palliative Care Center of Excellence, University of Washington Medicine, Seattle5Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: David
authors.initials: D
authors.lastname: Meltzer
authors.affiliation: Cambia Palliative Care Center of Excellence, University of Washington Medicine, Seattle5Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle.
authors.forename: Ruth
authors.initials: R
authors.lastname: Engelberg
authors.affiliation: Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island7Providence Veterans Administration Hospital, Providence, Rhode Island.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D006742:Hospital Bed Capacity; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000191:economics; D009735:Nursing Homes; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology