Fragmentation of care in the last year of life: Does dementia status matter?
Fragmentation of care in the last year of life: Does dementia status matter?
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DOI：
10.1111/jgs.17827
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发表时间：
2022-08
影响因子：
6.3
通讯作者：
Boyd, Cynthia
中科院分区：
文献类型：
--
作者：
Nothelle, Stephanie;Kelley, Amy S.;Zhang, Talan;Roth, David L.;Wolff, Jennifer L.;Boyd, Cynthia
在生命的最后一年，护理通常是分散的，但是，鲜为人知的是，在生命的最后一年（LYOL）的护理分散的常用措施。我们试图了解LYOL中重病老年人痴呆状态的护理碎片的差异。我们分析了国家健康和老龄化趋势研究中年龄≥65岁的成年人的数据，这些成年人在死亡前至少12个月死亡并与2011-2017年医疗保险服务费索赔相关联。我们将老年人分为患有痴呆症（以下简称痴呆症）导致的严重疾病、非痴呆症严重疾病或无严重疾病。对于门诊病人分割，我们计算了Bice-Boxerman连续性护理指数（COC）和已知的护理提供者指数（KPC），前者衡量护理集中度，后者衡量以前就诊的临床医生的比例。对于急性护理碎片化，我们将访问的医院和急诊科的数量除以总访问次数。我们为每种碎片化指标建立了单独的多变量分位数回归模型。在1793名老年人中，42%患有痴呆症，53%患有非痴呆症严重疾病，5%两者都没有。患有痴呆症的老年人比患有非痴呆症严重疾病的老年人住院更少，但比没有严重疾病的老年人更多（平均值1.9 vs 2.3 vs 1，p = 0.002）。在调整后的模型中，与患有非痴呆症严重疾病的老年人相比，痴呆症患者在COC的所有分位数（范围为0.016-0.110）中的分散护理显着减少，但KPC的预测第90百分位数较低，这意味着更多患有痴呆症的老年人在KPC测量中具有极其分散的护理。在急性护理碎片化方面没有显著差异。在LYOL中，患有痴呆症的老年人与患有非痴呆症严重疾病的老年人相比，COC指数的医疗保健接触较少，护理碎片较少。
Care at the end of life is commonly fragmented; however, little is known about commonly used measures of fragmentation of care in the last year of life (LYOL). We sought to understand differences in fragmentation of care by dementia status among seriously ill older adults in the LYOL. We analyzed data from adults ≥65 years in the National Health and Aging Trends Study who died and had linked 2011–2017 Medicare fee‐for‐service claims for ≥12 months before death. We categorized older adults as having serious illness due to dementia (hereafter dementia), non‐dementia serious illness or no serious illness. For outpatient fragmentation, we calculated the Bice–Boxerman continuity of care index (COC), which measures care concentration, and the known provider of care index (KPC), which measures the proportion of clinicians who were previously seen. For acute care fragmentation, we divided the number of hospitals and emergency departments visited by the total number of visits. We built separate multivariable quantile regression models for each measure of fragmentation. Of 1793 older adults, 42% had dementia, 53% non‐dementia serious illness and 5% neither. Older adults with dementia had fewer hospitalizations than older adults with non‐dementia serious illness but more than older adults without serious illness (mean 1.9 vs 2.3 vs 1, p = 0.002). In adjusted models, compared to older adults with non‐dementia serious illness, those with dementia had significantly less fragmented care across all quantiles of COC (range 0.016–0.110) but a lower predicted 90th percentile of KPC, meaning more older adults with dementia had extremely fragmented care on the KPC measure. There was no significant difference in acute care fragmentation. In the LYOL, older adults with dementia have fewer healthcare encounters and less fragmentation of care by the COC index than older adults with non‐dementia serious illness.
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影响因子：
120.7
作者：
Teno, Joan M.;Gozalo, Pedro L.;Bynum, Julie P. W.;Leland, Natalie E.;Miller, Susan C.;Morden, Nancy E.;Scupp, Thomas;Goodman, David C.;Mor, Vincent
通讯作者：
Mor, Vincent
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作者：
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通讯作者：
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Kern, Lisa M.;Safford, Monika M.;Abramson, Erika L.
通讯作者：
Abramson, Erika L.
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Pollack CE;Hussey PS;Rudin RS;Fox DS;Lai J;Schneider EC
通讯作者：
Schneider EC