Hospitalization of hospice patients with cancer.
Hospitalization of hospice patients with cancer.
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DOI：
10.1089/109662103322515266
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发表时间：
2003-10-01
影响因子：
2.8
通讯作者：
McCarthy, Ellen P
中科院分区：
文献类型：
--
作者：
Cintron, Alexie;Hamel, Mary B;McCarthy, Ellen P
目的：确定与老年癌症临终关怀患者住院相关的因素，并描述他们的住院经历。设计：对生命最后一年的回顾性分析。设置：监测、流行病学和最终结果（SEER）-医疗保险链接数据库。参与者：1988年至1998年间死于肺癌或结直肠癌并参加临终关怀的医疗保险受益人。测量：进入临终关怀后住院。对于住院患者，我们描述入院诊断，侵略性的护理，并在医院death.Results：在23608例患者中，1423（6.0%）住院后，临终关怀登记。随着时间的推移，临终关怀每年的住院率下降7.0%。与住院率较高相关的因素包括年龄较小、男性、黑人种族/民族、诊断时的当地癌症分期以及癌症诊断后4个月内的临终关怀登记。最常见的入院原因是肺癌、转移性疾病、骨折、肺炎和血容量不足。在1423例住院患者中，34.6%接受积极护理，35.8%死于hospital.CONCLUSION：老年肺癌或结直肠癌临终关怀患者的住院率似乎在下降。然而，住院的病人接受积极的护理，往往死在医院而不是家里。这种积极的护理可能与患者护理偏好的变化相一致，但也可能反映了急性护理医院目前的文化，这种文化侧重于治愈性治疗，而提供姑息治疗的设备不足。
OBJECTIVES: To identify factors associated with hospitalization of elderly hospice patients with cancer and to describe their hospital experiences.DESIGN: Retrospective analysis of the last year of life.SETTING: Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.PARTICIPANTS: Medicare beneficiaries dying of lung or colorectal cancer between 1988 and 1998 who enrolled in hospice.MEASUREMENTS: Hospitalization after hospice entry. For hospitalized patients, we describe admission diagnoses, aggressiveness of care, and in-hospital death.RESULTS: Of the 23608 patients, 1423 (6.0%) were hospitalized after hospice enrollment. Hospitalization declined over time by 7.0% per year of hospice enrollment. Factors associated with higher hospitalization rates were younger age, male gender, black race/ethnicity, local cancer stage at diagnosis, and hospice enrollment within 4 months of cancer diagnosis. The most common reasons for hospital admission were lung cancer, metastatic disease, bone fracture, pneumonia, and volume depletion. Of the 1423 patients hospitalized, 34.6% received aggressive care and 35.8% died in the hospital.CONCLUSION: The rates of hospitalization for elderly hospice patients with lung or colorectal cancer appear to be declining. However, patients who are hospitalized undergo aggressive care and often die in the hospital rather than at home. This aggressive care may be consistent with changes in patients' care preferences, but could also reflect the current culture of acute care hospitals, which focuses on curative treatment and is ill-equipped to provide palliative care.