TY - JOUR
T1 - Intensive care utilization among nursing home residents with advanced cognitive and severe functional impairment
AU - Fulton, Ana Tuya
AU - Gozalo, Pedro
AU - Mitchell, Susan L.
AU - Mor, Vince
AU - Teno, Joan M.
N1 - Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2014/3/1
Y1 - 2014/3/1
N2 - Background: Dementia is a progressive terminal illness which requires decisions around aggressiveness of care. Objective: The study objective was to examine the rate of intensive care unit (ICU) utilization and its regional variation among persons with both advanced cognitive and severe functional impairment. Methods: We utilized the Minimum Data Set (MDS) to identify a cohort of decedents between 2000 and 2007 who (1) were in a nursing home (NH) 120 days prior to death and (2) had an MDS assessment indicating advanced cognitive and functional impairment as identified by cognitive performance scale (CPS) ≥5 and total dependence or extensive assistance in seven activities of daily living (ADLs). ICU utilization in the last 30 days of life was determined from Medicare claims files. A multivariate logistic regression model examined the likelihood of ICU admission in 2007 versus 2000 adjusting for sociodemographics, orders to limit life sustaining treatment, and health status. Results: Among 474,829 Medicare NH residents with advanced cognitive impairment followed during 2000-2007, we observed an increase in ICU utilization from 6.1% in 2000 to 9.5% in 2007. After adjustment for sociodemographic characteristics, orders to limit life sustaining treatment, and measures of health status, the likelihood of a resident being admitted to an ICU was higher in 2007 compared to 2000 (adjusted odds ratio [OR] 1.71, 95% CI 1.60-1.81). Additionally, substantial regional variation was noted in ICU utilization, from 0.82% in Montana to 22% in the District of Columbia. Conclusions: Even among patients with advanced cognitive and functional impairment, ICU utilization in the last 30 days increased and varied by geographic region.
AB - Background: Dementia is a progressive terminal illness which requires decisions around aggressiveness of care. Objective: The study objective was to examine the rate of intensive care unit (ICU) utilization and its regional variation among persons with both advanced cognitive and severe functional impairment. Methods: We utilized the Minimum Data Set (MDS) to identify a cohort of decedents between 2000 and 2007 who (1) were in a nursing home (NH) 120 days prior to death and (2) had an MDS assessment indicating advanced cognitive and functional impairment as identified by cognitive performance scale (CPS) ≥5 and total dependence or extensive assistance in seven activities of daily living (ADLs). ICU utilization in the last 30 days of life was determined from Medicare claims files. A multivariate logistic regression model examined the likelihood of ICU admission in 2007 versus 2000 adjusting for sociodemographics, orders to limit life sustaining treatment, and health status. Results: Among 474,829 Medicare NH residents with advanced cognitive impairment followed during 2000-2007, we observed an increase in ICU utilization from 6.1% in 2000 to 9.5% in 2007. After adjustment for sociodemographic characteristics, orders to limit life sustaining treatment, and measures of health status, the likelihood of a resident being admitted to an ICU was higher in 2007 compared to 2000 (adjusted odds ratio [OR] 1.71, 95% CI 1.60-1.81). Additionally, substantial regional variation was noted in ICU utilization, from 0.82% in Montana to 22% in the District of Columbia. Conclusions: Even among patients with advanced cognitive and functional impairment, ICU utilization in the last 30 days increased and varied by geographic region.
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U2 - 10.1089/jpm.2013.0509
DO - 10.1089/jpm.2013.0509
M3 - Article
C2 - 24490881
AN - SCOPUS:84896268624
SN - 1096-6218
VL - 17
SP - 313
EP - 317
JO - Journal of palliative medicine
JF - Journal of palliative medicine
IS - 3
ER -