Survival in hospice patients with dementia: the effect of home hospice and nurse visits.
Survival in hospice patients with dementia: the effect of home hospice and nurse visits.
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DOI：
10.1111/jgs.17066
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发表时间：
2021-06
影响因子：
6.3
通讯作者：
Prigerson HG
中科院分区：
文献类型：
--
作者：
Luth EA;Russell DJ;Xu JC;Lauder B;Ryvicker MB;Dignam RR;Baughn R;Bowles KH;Prigerson HG
患有痴呆症的临终关怀患者活着出院和长时间住院(>；180天)的风险增加，给患者和家庭照顾者带来压力和负担。临床医生就诊的地点和时间是影响患者是否如预期死亡、在临终关怀中死亡、是否经历活着出院或长时间住院的重要因素。检查家庭临终关怀和护士探视频率与医疗保险预期的6个月内在临终关怀中死亡的关系。回顾性队列研究。非营利性临终关怀机构。2013年至2017年，3,837名痴呆症患者接受了临终关怀服务。多变量生存分析研究了接受家庭临终关怀(与疗养院相比)和护士就诊时间对临终关怀登记后6个月内死亡的影响，并与活着出院或长期住院进行了比较。模型会根据相关的人口统计和临床因素进行调整。39%(39%)的患者经历了活着出院或长期住院。家庭临终关怀患者更有可能经历活着出院或长时间住院(死亡比率：0.77，95%CI：0.69-0.86，p<；0.001)。护士就诊频率与出院时间和住院时间呈负相关(死亡危险比：2.87，95%可信区间：2.47-3.33，p<；0.001)。在我们的研究中，近40%的痴呆症患者经历了活着出院或长期住院。还需要更多的研究来了解为什么家庭临终关怀可能会导致痴呆症患者的出院或长时间住院。护士就诊与死亡有关，这表明他们对患者健康恶化的反应。临终关怀指南可能需要允许更长的停留时间，这样居住在社区的痴呆症患者-越来越多的临终关怀患者-才能继续参加临终关怀，并避免与实时出院相关的负担和成本。
Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospice, or experiences a live discharge or long length of stay. Examine how home hospice and nurse visit frequency relate to dying in hospice within the Medicare-intended 6-month period. Retrospective cohort study. Non-profit hospice agency. Three thousand eight hundred and thirty seven patients with dementia who received hospice services from 2013 to 2017. Multivariable survival analyses examined the effects of receiving home hospice (vs. nursing home) and timing of nurse visits on death within 6 months of hospice enrollment, compared to live discharge or long length of stay. Models adjust for relevant demographic and clinical factors. Thirty-nine percent (39%) of patients experienced live discharge or long length of stay. Home hospice patients were more likely to experience live discharge or long length of stays (HR for death: 0.77, 95%CI: 0.69–0.86, p < 0.001). Frequency of nurse visits was inversely associated with live discharge and long lengths of stay (HR for death: 2.87, 95%CI: 2.47–3.33, p < 0.001). Nearly 40% of patients with dementia in our study experienced live discharge or a long length of stay. Additional research is needed to understand why home hospice may result in live discharge or a long length of stay for patients with dementia. Nurse visits were associated with death, suggesting their responsiveness to deteriorating patient health. Hospice guidelines may need to permit longer stays so community-dwelling patients with dementia, a growing segment of hospice patients, can remain continuously enrolled in hospice and avoid burden and costs associated with live discharge.
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影响因子：
2.8
作者：
Head, Barbara;Ritchie, Christine S;Smoot, Tonya M
通讯作者：
Smoot, Tonya M
DOI：
10.5600/mmrr.004.02.b03
发表时间：
2014-01-01
期刊：
Medicare & medicaid research review
影响因子：
--
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通讯作者：
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作者：
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通讯作者：
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影响因子：
45.3
作者：
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通讯作者：
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影响因子：
4.7
作者：
Klinkenberg, M;Willems, DL;Deeg, DJH
通讯作者：
Deeg, DJH