Associations of Hospice Disenrollment and Hospitalization With Continuous Home Care Provision.
Associations of Hospice Disenrollment and Hospitalization With Continuous Home Care Provision.
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DOI：
10.1097/mlr.0000000000000776
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发表时间：
2017-09
期刊：
影响因子：
3
通讯作者：
Bradley E
中科院分区：
文献类型：
--
作者：
Wang SY;Dang W;Aldridge MD;Canavan M;Cherlin E;Bradley E
研究在提供CHC的临终关怀（CHC临终关怀）中登记的患者与在不提供CHC的临终关怀（非CHC临终关怀）中登记的患者的临终关怀退出率和临终关怀后住院率。我们对2011年7月至12月期间的医疗保险按服务收费死亡者进行了一项回顾性队列研究，这些死亡者年龄在66岁及以上，在生命的最后6个月内使用过临终关怀。我们使用倾向评分匹配来解释临终关怀的潜在混杂特征。广义估计方程模型被用来估计CHC临终关怀和非CHC临终关怀之间的协会临终关怀退出/住院，调整病人的特点。我们还进行了亚组分析，以检查该协会可能有不同的临终关怀规模，并通过登记谁收到CHC的百分比。匹配后，我们确定了936对CHC和非CHC收容所，以及平衡的组织特征。在完全校正的模型中，与非CHC临终关怀机构相比，CHC临终关怀机构的退出率显著更低（校正率比[ARR]：0.73，95%置信区间[CI]：0.60 - 0.87），住院率也更低（ARR：0.79，95% CI 0.66 - 0.95）。这些关联在较大的临终关怀机构（研究期间有超过175名登记者）和至少7.3%的登记者使用CHC的临终关怀机构中更为明显。CHC临终关怀有显着较低的临终关怀退出率和临终关怀后住院治疗，这表明CHC服务可以使更高质量的临终关怀。
To examine rates of hospice disenrollment and post-hospice hospitalization among patients that are enrolled in hospices that provide CHC (CHC hospices) compared with patients who are enrolled in hospices that do not offer CHC (non-CHC hospices). We performed a retrospective cohort study among Medicare fee-for-service decedents between July and December 2011, who were 66 years and older and had used hospice in their last 6 months of life. We used propensity score matching to account for potential confounding characteristics of hospices. Generalized estimating equation models were applied to estimate between CHC hospices and non-CHC hospices the associations of hospice disenrollment/hospitalization, adjusted for patient characteristics. We also conducted subgroup analyses to examine how the association might have differed by hospice size, and by the percentage of enrollees who received CHC. After matching, we identified 936 pairs of CHC and non-CHC hospices, well balanced in terms of organizational characteristics. In fully adjusted models, compared with non-CHC hospices, CHC hospices had significantly lower disenrollment rates (adjusted rate ratio [ARR]: 0.73, 95% confidence interval [CI]: 0.60–0.87), and lower hospitalization rates (ARR: 0.79, 95% CI 0.66–0.95). These associations were significantly more pronounced among larger hospices (those with more than 175 enrollees during study period), and among hospices in which at least 7.3% of enrollees used CHC. CHC hospices had significantly lower rates of hospice disenrollment and post-hospice hospitalization, suggesting CHC service available may enable higher quality of end-of-life care.