Predictors of emergency department attendance by people with dementia in their last year of life: Retrospective cohort study using linked clinical and administrative data
Predictors of emergency department attendance by people with dementia in their last year of life: Retrospective cohort study using linked clinical and administrative data
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DOI：
10.1016/j.jalz.2017.06.2267
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发表时间：
2018-01-01
影响因子：
14
通讯作者：
Higginson, Irene J.
中科院分区：
文献类型：
--
作者：
Sleeman, Katherine E.;Perera, Gayan;Higginson, Irene J.
简介：痴呆症医院死亡人数的下降被解释为临终关怀有所改善。临终关怀质量的其他指标，例如急诊室 (ED) 出勤率，是否表现出类似的趋势尚不清楚。方法：使用大型精神卫生保健提供者的电子病历进行回顾性队列研究，并与全国死亡率和医院使用数据 (2008-2013) 相关联。结果：在 4867 名患者中，78.6% (3824) 在生命的最后一年至少有过一次 ED 就诊（均值 2.13，标准差） 2.34，范围 0-54）。在此期间，急诊就诊率有所增加（与 2008-2009 年相比，2012-2013 年的发病率比为 1.62，95% 置信区间为 1.46-1.80）。讨论：痴呆症患者生命最后一年的急诊就诊很常见，而且还在增加。政策制定者必须关注更广泛的临终关怀不良指标以及死亡地点。 (C) 2017 年作者。由爱思唯尔公司代表阿尔茨海默病协会出版。
Introduction: A fall in hospital deaths in dementia has been interpreted as indicating an improvement in end-of-life care. Whether other indicators of quality of end-of-life care, such as emergency department (ED) attendance, show a similar trend is unclear.Methods: Retrospective cohort study using electronic medical records from a large mental health care provider, linked to national mortality and hospital use data (2008-2013).Results: Of 4867 patients, 78.6% (3824) had at least one ED attendance during their last year of life (mean 2.13, standard deviation 2.34, range 0-54). ED attendance increased over the time period (incidence rate ratio 1.62, 95% confidence interval 1.46-1.80 for 2012-2013 compared with 2008-2009).Discussion: ED attendance in the last year of life for people with dementia is common and is increasing. Policy makers must pay attention to a broader range of indicators of poor end-of-life care alongside the place of death. (C) 2017 The Authors. Published by Elsevier Inc. on behalf of the Alzheimer's Association.