What factors influence emergency department visits by patients with cancer at the end of life? Analysis of a 124,030 patient cohort
What factors influence emergency department visits by patients with cancer at the end of life? Analysis of a 124,030 patient cohort
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DOI：
10.1177/0269216317713428
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发表时间：
2018-02-01
影响因子：
4.4
通讯作者：
Gao, Wei
中科院分区：
文献类型：
--
作者：
Henson, Lesley A.;Higginson, Irene J.;Gao, Wei
背景：随着时间的推移，癌症患者在生命结束时到急诊室就诊的人数正在增加。尽管有证据表明，这与患者和护理人员的不良结局有关，而且大多数患者更喜欢家庭护理。目的：确定与临终急诊科就诊相关的社会人口统计学和临床因素，并确定患者既往急诊科使用与生命最后一个月多次就诊风险之间的关系。设计：基于人群的队列研究。设置/参与者：所有在2011年4月1日至2012年3月31日期间在英格兰死于癌症的成年人。我们的主要结果是在生命的最后一个月多次急诊就诊的调整优势比，使用多变量logistic regression.Results得出：在124，030例癌症死亡者中（52.9%为男性;平均年龄：74.1岁），30.7%在生命的最后一个月就诊过一次急诊，5.1%多次就诊。如果患者是男性、年轻人、亚洲人或黑人、社会经济地位较低、合并症较多、患有肺癌或头颈癌，则患者更有可能多次就诊。在生命的最后一个月之前的11个月内有4次急诊就诊的患者在生命的最后30天内也更有可能进行多次就诊;这遵循剂量-反应模式（p趋势
Background: Emergency department visits towards the end of life by patients with cancer are increasing over time. This is despite evidence of an association with poor patient and caregiver outcomes and most patients preferring home-based care.Aim: To identify socio-demographic and clinical factors associated with end-of-life emergency department visits and determine the relationship between patients' prior emergency department use and risk of multiple (2) visits in the last month of life.Design: Population-based cohort study.Setting/participants: All adults who died from cancer, in England, between 1 April 2011 and 31 March 2012. Our primary outcome was the adjusted odds ratio for multiple emergency department visits in the last month of life, derived using multivariable logistic regression.Results: Among 124,030 cancer decedents (52.9% men; mean age: 74.1years), 30.7% visited the emergency department once in their last month of life and 5.1% visited multiple times. Patients were more likely to visit multiple times if they were men, younger, Asian or Black, of lower socio-economic status, had greater comorbidity, and lung or head and neck cancer. Patients with 4 emergency department visits in the 11months prior to their last month of life were also more likely to make multiple visits during their last 30days; this followed a dose-response pattern (p for trend