2016 Volume 20 Issue 1 Pages 31-35
Objective: “The guideline about decision-making process for the introduction of artificial hydration and nutrition in elderly patients with dysphagia” (“the guidelines”) were published in 2012 as a project sponsored by the Ministry of Health, Labour and Welfare. In fiscal 2014, a series of revisions were made to further require the promotion of rehabilitation (rehab) for the transition from tube feeding to oral intake. We investigated the changes in the number of patients who transitioned to oral intake and who underwent percutaneous endoscopic gastrostomy (PEG). Additionally, we examined how the guidelines and the revision of the medical payment system affected the outcomes of patients in convalescent rehab wards.
Methods: We retrospectively reviewed medical records of inpatients consuming 3 meals a day via tube (36–45 patients/year) in the convalescent rehab wards of our hospital from 2010 to 2014.
Results: The number of patients who regained oral intake ability gradually increased from 2010 onward (from 8 patients [19%] in 2010 to 17 patients [38%] in 2014). According to the year of hospital admission, the patients were divided into the 2010–2011 group and 2012–2014 group. The number of patients who regained oral intake ability was significantly increased in the 2012–2014 group; in contrast, the number of PGE patients decreased significantly from 34 (79%) in the 2010–2011 group to 19 (42%) in the 2012–2014 group.
Discussion: The FIM (functional independence measure) score gain during hospitalization in the same period improved by about 5 points, possibly explaining the marked increase in the number of patients who transitioned to oral intake. The number of patients with PEG has shown a consistent decline since 2010, and this trend is not probably affected by the medical payment system revision. It may be affected by the fact that newspapers and books have begun to address the ethical issues pertaining to PEG often after the guidelines were published.
