Feeding Tube Use in Dementia Patients Linked to Pressure Ulcers
Good nursing homes, she says, "know how to hand feed the patient and know what cues to use to keep the patient eating, but the hospital can't do that."
"It becomes a pathway. The nursing home wants to maximize its money so they send the patient to the hospital," Teno explains. "The hospital wants to get that person out of there quickly so they can have a short stay and be under the number of hospital days they're reimbursed for under that DRG. So the system is not focused on really doing a good job of talking with families about the risks and benefits of these feeding tubes. Instead, there's a rush to put these in, and send the patients back to the nursing home."
"After looking at and writing a number of papers on this for 10 years, I really think we have the wrong financial incentives, and those incentives are doing more harm than good," Teno says. "This is just another example of another intervention that needs to be carefully thought out, to weigh the risks and benefits."
In an invited commentary, Colleen Christmas, MD, and Thomas Finucane, MD, both of the Division of Geriatric Medicine and Gerontology at Johns Hopkins Bayview Medical Center in Baltimore, said Teno's findings "extend and confirm most earlier studies in this area and are now the most rigorous data we have on this subject."
They added, "Teno and colleagues provide sophisticated additional evidence that pressure sore outcomes are not improved, in fact are worsened, among patients with dementia who receive additional nutrition via feeding tubes."
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
- Drug Pricing 'Tantamount to Greed,' Lawmaker Says
- CVS Ramps Up Retail Clinics with Provider Affiliations
- Study Puts Spotlight on Preventing Fall-Related Injuries
- Wanted: Nurse PhDs
- Surgical Checklists Unused in 10% of Hospitals, CMS Data Shows
- The Infection-Busting Treatment Payers Don’t Want to Talk About
- Contradictory Obamacare Rulings Issued by Appellate Courts
- 4 Tectonic Shifts Shaking Up Healthcare
- As HIPAA Breaches Accelerate, Tools Lag
- Doctors Feel Pressure to Accept Risk-based Reimbursement