End-of-life care for Medicare beneficiaries with cancer is highly intensive overall and varies widely.
End-of-life care for Medicare beneficiaries with cancer is highly intensive overall and varies widely.
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DOI：
10.1377/hlthaff.2011.0650
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发表时间：
2012-04
期刊：
影响因子：
--
通讯作者：
Goodman DC
中科院分区：
文献类型：
--
作者：
Morden NE;Chang CH;Jacobson JO;Berke EM;Bynum JP;Murray KM;Goodman DC
研究表明，接近生命末期的癌症护理比许多患者喜欢的更具侵略性。使用一组患有预后不良的癌症的已故联邦医疗保险受益人(这意味着他们可能在一年内死亡)，我们检查了医院特征与11项临终关怀措施之间的关联，如临终关怀使用和住院。我们的研究显示，在生命的最后几周，人们的护理强度相对较高。与此同时，具有共同特征的医院集团内部存在两倍以上的差异，如癌症中心指定和营利性地位。我们发现，这些医院特征很少解释所观察到的临终癌症护理强度的变化，并且没有一个可靠地预测特定的护理模式。这些发现提出了什么因素可能导致这种差异的问题。他们还建议，临终癌症护理的最佳做法可以在许多环境中找到，改善临终护理质量的努力应该包括每一类医院。
Studies have shown that cancer care near the end of life is more aggressive than many patients prefer. Using a cohort of deceased Medicare beneficiaries with poor-prognosis cancer, meaning that they were likely to die within a year, we examined the association between hospital characteristics and eleven end-of-life care measures, such as hospice use and hospitalization. Our study revealed a relatively high intensity of care in the last weeks of life. At the same time, there was more than a twofold variation within hospital groups with common features, such as cancer center designation and for-profit status. We found that these hospital characteristics explained little of the observed variation in intensity of end-of-life cancer care and that none reliably predicted a specific pattern of care. These findings raise questions about what factors may be contributing to this variation. They also suggest that best practices in end-of-life cancer care can be found in many settings and that efforts to improve the quality of end-of-life care should include every hospital category.
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