The Effects of an Inpatient Palliative Care Team on Discharge Disposition
The Effects of an Inpatient Palliative Care Team on Discharge Disposition
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DOI：
10.1089/jpm.2009.0300
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发表时间：
2010-05-01
影响因子：
2.8
通讯作者：
Harrington, Charlene
中科院分区：
文献类型：
--
作者：
Brody, Abraham Aizer;Ciemins, Elizabeth;Harrington, Charlene
概述：住院姑息治疗团队 (PCT) 对提高生活质量和患者满意度以及降低利用率和成本的贡献已得到充分证实。然而，尽管有证据表明临终关怀入院率、减少再住院率和提高资源利用率之间存在关联，但很少有研究探讨住院 PCT 对出院处置的具体影响。方法：将 2004 年 6 月至 2007 年 12 月期间入住一家大型非营利性多点医院并接受 PCT 诊治的患者与常规护理 (UC) 患者的年龄、死亡风险、前一年住院天数和疾病严重程度进行匹配。出院处理和人口因素是从医院行政索赔中提取的；死亡率数据是从社会保障死亡指数中收集的。使用 Wilcoxon 检验、chi(2) 分析和多项 Logit 回归进行分析。结果：三百六十一个匹配对可用于分析。与 UC 相比，在控制患者人口统计和疾病严重程度的情况下，接受 PCT 会诊的患者出院前往临终关怀医院的可能性高出 3.24 倍（p < 0.0001），出院前往护理机构的可能性高出 1.52 倍，出院回家接受服务的可能性高出 1.59 倍（p < 0.001）。 PCT 患者也在其疾病轨迹的早期而不是在生命的最后几周被转诊至临终关怀中心。结论：接受住院 PCT 咨询的患者更有可能在出院后接受后续服务。这些服务可能有助于提高护理质量和经济效益，值得进一步研究，特别是考虑到当前对医疗保健效率和质量的关注。
Overview: Inpatient palliative care teams' (PCT) contribution to improved quality of life and patient satisfaction as well as decreased utilization and costs has been well established. Yet few studies have examined the specific effect of an inpatient PCT on discharge disposition, despite evidence of an association between hospice enrollment, decreased rehospitalization, and improved resource utilization.Methods: Patients admitted to a large nonprofit multisite hospital between June 2004 and December 2007 and seen by the PCT were matched to usual care (UC) patients on age, mortality risk, prior year hospitalized days, and disease severity. Discharge disposition and demographic factors were abstracted from hospital administrative claims; mortality data was collected from the social security death index. Analyses were performed using Wilcoxon's test, chi(2) analysis, and multinomial logit regression.Results: Three hundred sixty-one matched pairs were available for analysis. Compared to UC, patients who received a PCT consultation were 3.24 times more likely to be discharged to hospice (p < 0.0001), 1.52 times more likely to be discharged to a nursing facility, and 1.59 times more likely to be discharged home with services (p < 0.001), controlling for patient demographics and disease severity. PCT patients were also referred to hospice earlier in their disease trajectory, rather than in the last few weeks of life.Conclusion: Patients receiving an inpatient PCT consultation are more likely to receive follow-up services upon discharge from the hospital. These services likely contribute to better quality of care and financial benefits, and warrants further study, especially considering the current focus on health care efficiency and quality.