How many people need palliative care? A study developing and comparing methods for population-based estimates
How many people need palliative care? A study developing and comparing methods for population-based estimates
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DOI：
10.1177/0269216313489367
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发表时间：
2014-01-01
影响因子：
4.4
通讯作者：
Higginson, Irene J.
中科院分区：
文献类型：
--
作者：
Murtagh, Fliss E. M.;Bausewein, Claudia;Higginson, Irene J.
背景资料：了解姑息治疗的需求是必不可少的规划services.Aim：完善现有的方法估计人口为基础的姑息治疗的需求，并比较这些方法，以更好地告知其use.Design：（1）完善现有的人口为基础的方法，基于专家小组的意见，和（2）应用/比较现有的和完善的方法在一个示例数据集中。现有方法在方法和数据来源方面各不相同。(a)Higginson使用死因/症状患病率，并使用疼痛患病率，估计60.28%（95%置信区间= 60.20%-60.36%）所有死亡需要姑息治疗，（B）Rosenwax使用疾病和相关健康问题国际统计分类-第10次修订版（ICD-10）死亡原因/医院使用数据，估计有37.01%（95%置信区间= 36.94%-37.07%）至96.61%（95%置信区间= 96.58%-96.64%）死亡需要姑息治疗，以及（c）戈麦斯-巴蒂斯特使用死亡百分比加上慢性病数据，并估计75%的死亡需要姑息治疗。设置/参与者：2006年1月至2008年12月英格兰所有死亡，使用相关死亡率和医院事件数据。结果：专家小组审查确定了不断变化的做法（例如，将姑息治疗扩展到更多的非癌症疾病），改变医院/家庭护理模式，死亡原因同样重要。因此，我们改进了（使用更新的ICD-10死亡原因、潜在/促成原因和医院使用）估计至少63.03%（95%置信区间= 62.95%-63.11%），中下限和中上限估计值在69.10%之间（95%置信区间= 69.02%-69.17%）和81.87%（95%可信区间= 81.81%-81.93%）。使用潜在和促成原因的死亡登记数据可以可靠地估计基于人口的姑息治疗需求，而不需要症状或医院活动数据。在高收入国家，69%-82%的死亡者需要姑息治疗。
Background: Understanding the need for palliative care is essential in planning services.Aim: To refine existing methods of estimating population-based need for palliative care and to compare these methods to better inform their use.Design: (1) Refinement of existing population-based methods, based on the views of an expert panel, and (2) application/comparison of existing and refined approaches in an example dataset. Existing methods vary in approach and in data sources. (a) Higginson used cause of death/symptom prevalence, and using pain prevalence, estimates that 60.28% (95% confidence interval = 60.20%-60.36%) of all deaths need palliative care, (b) Rosenwax used the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) causes of death/hospital-use data, and estimates that 37.01% (95% confidence interval = 36.94%-37.07%) to 96.61% (95% confidence interval = 96.58%-96.64%) of deaths need palliative care, and (c) Gomez-Batiste used percentage of deaths plus chronic disease data, and estimates that 75% of deaths need palliative care.Setting/participants: All deaths in England, January 2006-December 2008, using linked mortality and hospital episode data.Results: Expert panel review identified changing practice (e.g. extension of palliative care to more non-cancer conditions), changing patterns of hospital/home care and multiple, rather than single, causes of death as important. We therefore refined methods (using updated ICD-10 causes of death, underlying/contributory causes, and hospital use) to estimate a minimum of 63.03% (95% confidence interval = 62.95%-63.11%) of all deaths needing palliative care, with lower and upper mid-range estimates between 69.10% (95% confidence interval = 69.02%-69.17%) and 81.87% (95% confidence interval = 81.81%-81.93%).Conclusions: Death registration data using both underlying and contributory causes can give reliable estimates of the population-based need for palliative care, without needing symptom or hospital activity data. In high-income countries, 69%-82% of those who die need palliative care.