Association of health care expenditures with aggressive versus palliative care for cancer patients at the end of life: A cross-sectional study using claims data in Japan.
Association of health care expenditures with aggressive versus palliative care for cancer patients at the end of life: A cross-sectional study using claims data in Japan.
复制标题
癌症患者临终时的医疗保健支出与积极与姑息治疗的关联：一项使用日本索赔数据的横断面研究。
DOI：
10.1093/intqhc/mzt081
复制
发表时间：
2014
影响因子：
2.6
通讯作者：
Imanaka Y.
中科院分区：
文献类型：
--
作者：
Morishima T;Lee J;Otsubo T;Imanaka Y.
临终关怀给患者和医疗保险公司带来了沉重的经济负担。目的从健康保险公司的角度探讨晚期癌症患者的积极与姑息治疗的基准指标与医疗费用之间的关系。设计使用健康保险索赔数据的横断面回顾性研究。设置/参与者在京都县死亡的癌症患者，日本，2009年4月至2010年5月。主要结果measureClaims数据进行了分析，使用多层次广义线性模型，以检查是否积极的护理和姑息治疗与支出在过去3个月的生命，调整后的患者特征，医院的特点和其他非指标procedures.ResultsWe分析了3143死者从54家医院。在过去3个月内，每名患者的中位支出为13 030美元。较高的支出与急性护理医院的较高死亡率和生命最后一个月使用化疗的积极护理指标相关，以及与生命最后3个月增加临终关怀和阿片类药物使用的姑息治疗指标相关。然而，在过去的3个月增加医生家庭护理与较低的expenditure.ConclusionsIndicators的侵略性和姑息性的EOL护理与较高的医疗费用。这些结果可能支持措施的协调发展，以优化积极的护理和减少晚期癌症护理的经济负担。
BackgroundEnd-of-life (EOL) care imposes heavy economic burdens on patients and health insurers. Little is known about the association between the types of EOL care and healthcare costs for cancer patients across various providers.ObjectiveTo explore the association of healthcare expenditures with benchmarking indicators of aggressive versus palliative care among terminally ill cancer patients, from the perspective of health insurers.DesignCross-sectional retrospective study using health insurance claims data.Setting/participantsCancer patients who had died in Kyoto prefecture, Japan, between April 2009 and May 2010.Main outcome measureClaims data were analyzed using multilevel generalized linear models to examine whether aggressive care and palliative care were associated with expenditures during the last 3 months of life, after adjusting for patient characteristics, hospital characteristics and other non-indicator procedures.ResultsWe analyzed 3143 decedents from 54 hospitals. Median expenditure per patient during the last 3 months was US$13 030. Higher expenditures were associated with the aggressive care indicators of higher mortality at acute-care hospitals and use of chemotherapy in the last month of life, as well as with the palliative care indicators of increased hospice care and opioid use in the last 3 months of life. However, increased physician home care in the last 3 months was associated with lower expenditure.ConclusionsIndicators of both aggressive and palliative EOL care were associated with higher healthcare expenditures. These results may support the coherent development of measures to optimize aggressive care and reduce the financial burdens of terminal cancer care.