Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasets.
Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasets.
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DOI：
10.1136/bmjopen-2020-041888
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发表时间：
2020-11-23
期刊：
影响因子：
2.9
通讯作者：
Boyd K
中科院分区：
文献类型：
--
作者：
Mason B;Kerssens JJ;Stoddart A;Murray SA;Moine S;Finucane AM;Boyd K
分析人们在生命的最后一年使用计划外国民保健服务（NHS）服务的模式和成本。应用标准英国成本计算对国家数据集进行回顾性队列分析。2016年在苏格兰死亡的所有18岁或以上的人（N= 56407）。在生命的最后12个月内，按死亡的根本原因、患者人口统计学资料、每次护理期间患者遵循的连续非计划途径（CUP）、总NHS和每例患者成本列出的5种非计划NHS服务的使用频率。53509例患者（94.9%）在生命的最后一年（472360次接触）至少有一次计划外护理服务，其中34.2%在生命的最后一个月。通过将每个护理阶段的患者联系起来，我们确定了206841例CUP，其中133980例（64.8%）开始于非工作时间。癌症患者更有可能联系NHS电话咨询热线（63%）（χ2（4）=1004，p<0.001）或非工作时间的初级保健（62%）（χ2（4）=1924，p<0.001），并住院（88%）（χ2（4）=2644，p<0.001）。器官衰竭患者（79%）最常联系救护车服务（χ2（4）=584，p<0.001）。与更多计划外护理相关的人口因素是年龄较大、社会剥夺、住在自己家里和死于癌症。死于器官衰竭的人构成了队列中最大的群体，并且作为一个群体，NHS成本最高。在社区提供服务的成本估计为3.9%的计划外护理总成本，尽管处理大多数非工作时间的电话。超过90%的人在生命的最后一年使用NHS计划外护理。不同的潜在死亡原因和人口因素影响了最初的获得和随后的护理途径。在社区管理更多的计划外护理事件有可能减少住院人数和总成本。
To analyse patterns of use and costs of unscheduled National Health Service (NHS) services for people in the last year of life. Retrospective cohort analysis of national datasets with application of standard UK costings. All people who died in Scotland in 2016 aged 18 or older (N=56 407). Frequency of use of the five unscheduled NHS services in the last 12 months of life by underlying cause of death, patient demographics, Continuous Unscheduled Pathways (CUPs) followed by patients during each care episode, total NHS and per-patient costs. 53 509 patients (94.9%) had at least one contact with an unscheduled care service during their last year of life (472 360 contacts), with 34.2% in the last month of life. By linking patient contacts during each episode of care, we identified 206 841 CUPs, with 133 980 (64.8%) starting out-of-hours. People with cancer were more likely to contact the NHS telephone advice line (63%) (χ2 (4)=1004, p<0.001) or primary care out-of-hours (62%) (χ2 (4)=1924, p<0.001) and have hospital admissions (88%) (χ2 (4)=2644, p<0.001). People with organ failure (79%) contacted the ambulance service most frequently (χ2 (4)=584, p<0.001). Demographic factors associated with more unscheduled care were older age, social deprivation, living in own home and dying of cancer. People dying with organ failure formed the largest group in the cohort and had the highest NHS costs as a group. The cost of providing services in the community was estimated at 3.9% of total unscheduled care costs despite handling most out-of-hours calls. Over 90% of people used NHS unscheduled care in their last year of life. Different underlying causes of death and demographic factors impacted on initial access and subsequent pathways of care. Managing more unscheduled care episodes in the community has the potential to reduce hospital admissions and overall costs.
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