Table 2.
Hospital Characteristics Associated With Feeding Tube Insertion Adjusted for Patient Characteristics
| No. (%) |
Feeding Tube Insertions, AOR (95% CI) |
|||||
|---|---|---|---|---|---|---|
| Characteristics | Hospitals (n = 2797) | Hospital Admissions (n = 280 869) | Feeding Tube Insertions (n = 19 847) | Unadjusted Feeding Tube Insertion Rate per 100 Admissions (95% CI) | With Hospital Characteristics Only (n = 275 410) | With Hospital and Patient Characteristics (n = 275 410) a |
| Ownership | ||||||
| Government | 416 (14.9) | 31 744 (11.3) | 1734 (8.7) | 5.5 (5.2–5.7) | 1 [Reference] | 1 [Reference] |
| Not-for-profit private | 1478 (52.8) | 161 989 (57.7) | 11 803 (59.5) | 6.8 (6.7–7.0) | 1.06 (.97–1.16) | 1.15 (1.06–1.25) |
| For profit | 518 (18.5) | 45 041 (16.0) | 3846 (19.3) | 8.5 (8.3–8.8) | 1.33 (1.20–1.48) | 1.33 (1.21–1.46) |
| Not-for-profit church | 383 (13.7) | 42 031 (15.0) | 3183 (16.0) | 7.6 (7.3–7.8) | 1.16 (1.04–1.30) | 1.29 (1.16–1.42) |
| No. of beds | ||||||
| <101 | 692 (24.7) | 39 487 (14.1) | 1711 (8.6) | 4.3 (4.1–4.5) | 1 [Reference] | 1 [Reference] |
| 101–182 | 701 (25.1) | 55 708 (19.8) | 3715 (18.7) | 6.7 (6.5–6.9) | 1.42 (1.29–1.56) | 1.40 (1.29–1.53) |
| 183–310 | 702 (25.1) | 78 209 (27.8) | 5820 (29.3) | 7.4 (7.2–7.6) | 1.52 (1.38–1.67) | 1.48 (1.36–1.62) |
| >310 | 702 (25.1) | 107 465 (38.3) | 8601 (43.3) | 8.0 (7.8–8.2) | 1.57 (1.42–1.75) | 1.48 (1.35–1.63) |
| Medical school affiliation | 862 (30.8) | 109 710 (39.1) | 8343 (42.0) | 7.6 (7.4–7.8) | 0.88 (0.80–0.96) | 0.90 (0.83–0.98) |
| Accredited for GME | 666 (23.8) | 81 966 (29.2) | 6597 (33.2) | 8.0 (7.9–8.2) | 1.24 (1.12–1.37) | 1.10 (1.01–1.20) |
| Urban location | 1990 (71.2) | 225 813 (80.4) | 17 236 (86.8) | 7.6 (7.5–7.7) | 1.13 (1.04–1.23) | 1.16 (1.07–1.25) |
| ICU use among decedents with chronic illness that used that hospitala | ||||||
| Lowest decile | 267 (10.0) | 18 372 (6.70 | 541 (2.8) | 2.9 (2.7–3.2) | 1 [Reference] | 1 [Reference] |
| 2nd decile | 268 (10.0) | 21 992 (8.0) | 1135 (5.8) | 5.2 (4.9–5.4) | 1.71 (1.47–2.00) | 1.53 (1.33–1.77) |
| 3rd decile | 266 (9.9) | 27 684 (10.1) | 1332 (6.8) | 4.8 (4.6–5.1) | 1.53 (1.30–1.80) | 1.38 (1.19–1.61) |
| 4th decile | 269 (10.0) | 24 460 (8.9) | 1727 (8.8) | 7.1 (6.7–7.4) | 2.30 (1.96–2.70) | 1.94 (1.67–2.24) |
| 5th decile | 250 (9.3) | 22 694 (8.2) | 1376 (7.0) | 6.1 (5.7–6.4) | 2.12 (1.81–2.51) | 1.77 (1.52–2.05) |
| 6th decile | 286 (10.7) | 30 430 (11.1) | 1921 (9.8) | 6.3 (6.0–6.6) | 1.94 (1.65–2.28) | 1.60 (1.38–1.85) |
| 7th decile | 265 (9.9) | 29 944 (10.9) | 2089 (10.7) | 7.0 (6.7–7.2) | 2.23 (1.90–2.62) | 1.76 (1.52–2.05) |
| 8th decile | 268 (10.0) | 36 226 (13.2) | 3405 (17.4) | 9.4 (9.1–9.7) | 2.77 (2.34–3.27) | 2.04 (1.75–2.38) |
| 9th decile | 269 (10.0) | 28 340 (10.3) | 2440 (12.5) | 8.6 (8.3–8.9) | 3.00 (2.52–3.55) | 2.23 (1.90–2.60) |
| Highest decile | 271 (10.1) | 35 268 (12.8) | 3570 (18.3) | 10.1 (9.8–10.4) | 3.62 (3.02–4.34) | 2.60 (2.20–3.06) |
| Specialist to primary care physician ratio per 1000 decedentsa | ||||||
| Lowest decile | 264 (9.8) | 19 640 (7.1) | 698 (3.6) | 3.6 (3.3–3.8) | 1 [Reference] | 1 [Reference] |
| 2nd decile | 238 (8.9) | 21 992 (8.0) | 1449 (7.4) | 6.6 (6.2–6.9) | 1.23 (1.05–1.45) | 1.08 (0.93–1.25) |
| 3rd decile | 296 (11.1) | 26 377 (9.6) | 1537 (7.9) | 5.8 (5.5–6.1) | 1.15 (0.99–1.35) | 1.01 (0.88–1.16) |
| 4th decile | 240 (9.0) | 25 200 (9.2) | 1392 (7.1) | 5.5 (5.2–5.8) | 1.29 (1.09–1.52) | 1.16 (1.00–1.35) |
| 5th decile | 296 (11.1) | 28 828 (10.5) | 2075 (10.6) | 7.2 (6.6–7.9) | 1.36 (1.16–1.59) | 1.18 (1.03–1.37) |
| 6th decile | 239 (8.9) | 31 810 (11.6) | 2892 (14.8) | 9.1 (8.8–9.4) | 1.48 (1.27–1.73) | 1.25 (1.09–1.44) |
| 7th decile | 302 (11.3) | 29 054 (10.6) | 2020 (10.3) | 6.9 (6.7–7.2) | 1.18 (1.00–1.39) | 1.10 (0.95–1.27) |
| 8th decile | 265 (9.9) | 28 749 (10.4) | 1851 (9.5) | 6.4 (6.2–6.7) | 1.03 (0.87–1.21) | 0.98 (0.84–1.14) |
| 9th decile | 227 (8.5) | 26 952 (9.8) | 2321 (11.9) | 8.6 (8.3–8.9) | 1.16 (0.97–1.38) | 1.04 (0.89–1.22) |
| Highest decile | 312 (11.7) | 36 808 (13.4) | 3301 (16.9) | 9.0 (8.7–9.3) | 1.10 (0.92–1.31) | 0.97 (0.83–1.13) |
| Hospice use among decedents with chronic illness that used that hospitala | ||||||
| Lowest decile | 257 (9.6) | 32 453 (11.8) | 2848 (14.6) | 8.8 (8.5–9.1) | 1 [Reference] | 1 [Reference] |
| 2nd decile | 276 (10.3) | 27 536 (10.0) | 2199 (11.3) | 8.0 (7.7–8.3) | 1.09 (0.94–1.26) | 1.06 (0.93–1.20) |
| 3rd decile | 265 (9.9) | 29 551 (10.7) | 1684 (8.6) | 5.7 (5.4–6.0) | 0.87 (0.75–1.00) | 0.84 (0.74–0.95) |
| 4th decile | 265 (9.9) | 25 997 (9.4) | 1690 (8.6) | 6.5 (6.2–6.7) | 0.83 (0.73–0.95) | 0.84 (0.75–0.95) |
| 5th decile | 274 (10.2) | 30 386 (11.0) | 1866 (9.6) | 6.1 (5.9–6.4) | 0.87 (0.75–1.00) | 0.87 (0.76–0.99) |
| 6th decile | 268 (10.0) | 25 523 (9.3) | 1753 (9.0) | 6.9 (6.6–7.2) | 1.06 (0.92–1.23) | 0.99 (0.87–1.13) |
| 7th decile | 269 (10.0) | 26 722 (9.7) | 2090 (10.7) | 7.8 (7.5–8.1) | 1.07 (0.93–1.23) | 0.95 (0.84–1.08) |
| 8th decile | 268 (10.0) | 26 017 (9.5) | 1913 (9.8) | 7.4 (7.0–7.7) | 0.98 (0.85–1.12) | 0.95 (0.84–1.08) |
| 9th decile | 242 (9.0) | 25 993 (9.4) | 1751 (9.0) | 6.7 (6.4–7.0) | 0.91 (0.79–1.05) | 0.91 (0.81–1.04) |
| Highest decile | 295 (11.0) | 25 232 (9.2) | 1742 (8.9) | 6.9 (6.6–7.2) | 1.10 (0.96–1.27) | 1.01 (0.89–1.15) |
Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; GME, graduate medical education; ICU, intensive care unit.
a
Data from the Dartmouth Atlas of Health Care were available for 2679 of 2797 hospitals, resulting in 5459 missing hospital admissions. The final model adjusted for the year of admission, the number of days between the 1999–2007 Nursing Home Minimum Data Set assessment and hospital admission, and number of previous hospital admissions, plus the patient characteristics of age, sex, race/ethnicity, medical history, advance directives, durable power of attorney for health care, written orders to forgo life-sustaining treatment, and cognitive performance status and activities of daily living score indicating severe impairment.