Differences in Caregiver Reports of the Quality of Hospice Care Across Settings
Differences in Caregiver Reports of the Quality of Hospice Care Across Settings
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DOI：
10.1111/jgs.16361
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发表时间：
2020-02-10
影响因子：
6.3
通讯作者：
Anhang Price, Rebecca
中科院分区：
文献类型：
--
作者：
Quigley, Denise D.;Parast, Layla;Anhang Price, Rebecca
目的 通过设置检查报告的临终关怀体验的变化。设计医疗保健提供者和系统临终关怀 (CAHPS (R)) 的消费者评估 (CAHPS (R)) 对 2016 年的调查数据进行了分析。使用多元线性回归分析来检查不同护理环境（家庭、疗养院 [NH]、医院、独立临终关怀住院病房 [IPU] 和辅助生活设施 [ALF]）的测量分数差异。环境 共有 2636 个美国临终关怀机构。参与者 共有 311,635 名在临终关怀中死亡的患者的主要护理人员。测量结果是七项临终关怀质量测量，包括五项综合指标评估对患者和家庭重要的临终关怀方面的措施，包括临终关怀团队的沟通、护理的及时性、尊重家庭成员、症状管理以及情感和精神支持，以及临终关怀总体评级和向朋友和家人推荐临终关怀的意愿的两项全球衡量标准。根据调查管理模式和临终关怀机构之间病例组合的差异对分析进行了调整。 结果 在新罕布什尔州接受临终关怀护理的死者的照顾者报告说，在所有措施中，其经历均明显比在家中的照顾者差。除提供情感和精神支持外，所有指标的 ALF 分数也显着低于在家。与在家中相比，NH 和 ALF 环境中的临终关怀团队沟通（范围从 -11 到 -12，0-100 等级）和获得症状帮助（范围从 -7 到 -10）方面的差异特别大。在所有护理环境中，临终关怀团队的沟通、尊重家庭成员以及提供情感和精神支持与护理的整体评级密切相关。结论 存在改善 NH 和 ALF 临终关怀质量的重要机会。需要针对 NH 和 ALF 环境进行质量改进和监管干预，以确保所有临终关怀死者及其家人获得高质量、以患者和家庭为中心的临终关怀护理。
OBJECTIVES To examine variation in reported experiences with hospice care by setting.DESIGN Consumer Assessment of Healthcare Providers and Systems Hospice (CAHPS (R)) Survey data from 2016 were analyzed. Multivariate linear regression analysis was used to examine differences in measure scores by setting of care (home, nursing home [NH], hospital, freestanding hospice inpatient unit [IPU], and assisted living facility [ALF]).SETTING A total of 2636 US hospices.PARTICIPANTS A total of 311 635 primary caregivers of patients who died in hospice.MEASUREMENTS Outcomes were seven hospice quality measures, including five composite measures that assess aspects of hospice care important to patients and families, including hospice team communication, timeliness of care, treating family member with respect, symptom management, and emotional and spiritual support, and two global measures of the overall rating of the hospice and willingness to recommend it to friends and family. Analyses were adjusted for mode of survey administration and differences in case-mix between hospices.RESULTS Caregivers of decedents who received hospice care in a NH reported significantly worse experiences than caregivers of those in the home for all measures. ALF scores were also significantly lower than home for all measures, except providing emotional and spiritual support. Differences in NH and ALF settings compared to home were particularly large for hospice team communication (ranging from -11 to -12 on a 0-100 scale) and getting help for symptoms (ranging from -7 to -10). Consistently across all care settings, hospice team communication, treating family member with respect, and providing emotional and spiritual support were most strongly associated with overall rating of care.CONCLUSIONS Important opportunities exist to improve quality of hospice care in NHs and ALFs. Quality improvement and regulatory interventions targeting the NH and ALF settings are needed to ensure that all hospice decedents and their family receive high-quality, patient- and family-centered hospice care.