Loading...
Please wait, while we are loading the content...
Similar Documents
End-of-life Care for Nursing Home Residents with Advanced Dementia and Feeding Problems: a Cost-consequence Analysis
| Content Provider | Semantic Scholar |
|---|---|
| Author | Caprio, Thomas V. Holloway, Robert G. McCann, Robert M. |
| Copyright Year | 2007 |
| Abstract | Introduction: Advanced dementia may involve eating problems, swallowing difficulties, or loss of interest in food. Families and nursing homes are often faced with a difficult decision-making process regarding medical care including administration of artificial nutrition/hydration and continued hospitalization for complicating illnesses. This project performs a comprehensive cost-consequence analysis of different treatment pathways for nursing home residents with advanced dementia and feeding problems. Methods: A two-component cost-consequence model was developed using TreeAge Pro 2006 software. The first component compared the costs associated with percutaneous endoscopic gastrostomy (PEG) feeding tube placement verses hand-feeding by staff. The second component compares costs associated with management of a single episode of aspiration pneumonia in the nursing home verses acute hospitalization. Cost estimates were obtained from published peer-reviewed literature. The mortality and risk of developing aspiration pneumonia was assumed to be uniform throughout the model. Results: Total societal costs appear to be equivalent between tube feeding and hand feeding at approximately $18,000 including treatment of aspiration pneumonia in the hospital, and a range $10,000 $11,000 for treatment in the nursing home. The costs from payer perspectives of Medicare, Medicaid, and nursing home show considerable differences. Medicare has the highest costs with PEG tube placement and hospitalizations for pneumonia at nearly $13,000. Medicaid costs for tube feeding is less than $5,000 and this compares to over $6,000-$7,000 for hand feeding. The nursing home experiences the highest costs associated with hand feeding and pneumonia treatment onsite, due to increased staff costs exceeding $8,000. Nursing homes overall receive higher reimbursements and have lower costs with PEG tubes. Conclusions: This provides further evidence that conflicting financial incentives may result from chosen treatment pathways for advanced dementia in the nursing home. It must be considered that these external financial aspects may provide subtle influences on treatment decisions beyond that of evidence-based outcomes and value-based preferences of decision-makers. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://www.compassionandsupport.org/pdfs/research/AGS_PEG_Handout_2007.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
