Journal of the American Medical Directors Association · 2026
Prospective Study on the Clinical and Economic Impact of On-Site Flexible Endoscopic Evaluation of Swallowing in Residential Aged Care.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Fong Raymond, Ng Ruby Wing Yi, Lai Ronald, Kwan Connie Ching Yin, Ng Tsz Kwan, Chan Jason Ying Kuen, Ku Peter Ka Ming
Аннотация
OBJECTIVES: Oropharyngeal dysphagia affects approximately 50% of nursing home residents, yet access to instrumental assessment is often restricted by the logistical burdens of hospital transport. This diagnostic gap frequently results in suboptimal management and unnecessary dietary restrictions. This study aimed to evaluate the feasibility, clinical applicability, and cost-effectiveness of implementing an on-site flexible endoscopic evaluation of swallowing (FEES) service in residential aged care facilities.
DESIGN: Prospective cohort study.
SETTING AND PARTICIPANTS: Fifty residents (mean age, 82.3 years) with suspected dysphagia residing across 15 nursing homes operated by a nongovernmental organization in Hong Kong.
METHODS: Residents underwent on-site FEES. Feasibility was defined by completion rates (>75%) and monitoring for adverse events. A cost-minimization analysis compared the on-site model against the standard hospital referral pathway. Clinical applicability was assessed by preassessment and postassessment management changes. Stakeholder perceptions were evaluated via structured questionnaires.
RESULTS: The procedure proved highly feasible with a 96.0% completion rate (48/50) and no major adverse events. Clinical management changed for 75.0% (36/48) of participants, with 62.5% (30/48) of residents safely upgraded from overly restricted diets. The cost-minimization analysis demonstrated a 36.7% reduction per case (Hong Kong $1816 vs Hong Kong $2868), primarily because of savings in transport and escort manpower. While satisfaction was high, staff identified a lack of specialized training as the primary barrier to implementation.
CONCLUSIONS AND IMPLICATIONS: Findings from this preliminary cohort study suggest that an on-site FEES service represents a highly feasible and promising approach that may offer safe, logistically efficient dysphagia management in residential care. By shifting diagnostics to the bedside, facilities have the potential to safely reverse unnecessary dietary restrictions and reduce costly logistical overheads. However, given the limited sample scope, larger controlled trials are required to confirm long-term systemic safety and definitive cost-effectiveness before widespread adoption.
DESIGN: Prospective cohort study.
SETTING AND PARTICIPANTS: Fifty residents (mean age, 82.3 years) with suspected dysphagia residing across 15 nursing homes operated by a nongovernmental organization in Hong Kong.
METHODS: Residents underwent on-site FEES. Feasibility was defined by completion rates (>75%) and monitoring for adverse events. A cost-minimization analysis compared the on-site model against the standard hospital referral pathway. Clinical applicability was assessed by preassessment and postassessment management changes. Stakeholder perceptions were evaluated via structured questionnaires.
RESULTS: The procedure proved highly feasible with a 96.0% completion rate (48/50) and no major adverse events. Clinical management changed for 75.0% (36/48) of participants, with 62.5% (30/48) of residents safely upgraded from overly restricted diets. The cost-minimization analysis demonstrated a 36.7% reduction per case (Hong Kong $1816 vs Hong Kong $2868), primarily because of savings in transport and escort manpower. While satisfaction was high, staff identified a lack of specialized training as the primary barrier to implementation.
CONCLUSIONS AND IMPLICATIONS: Findings from this preliminary cohort study suggest that an on-site FEES service represents a highly feasible and promising approach that may offer safe, logistically efficient dysphagia management in residential care. By shifting diagnostics to the bedside, facilities have the potential to safely reverse unnecessary dietary restrictions and reduce costly logistical overheads. However, given the limited sample scope, larger controlled trials are required to confirm long-term systemic safety and definitive cost-effectiveness before widespread adoption.