Comparing hospice and nonhospice patient survival among patients who die within a three-year window
Comparing hospice and nonhospice patient survival among patients who die within a three-year window
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DOI：
10.1016/j.jpainsymman.2006.10.010
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发表时间：
2007-03-01
影响因子：
4.7
通讯作者：
Iwasaki, Kosuke
中科院分区：
文献类型：
--
作者：
Connor, Stephen R.;Pyenson, Bruce;Iwasaki, Kosuke
一些卫生保健提供者和更广泛的社区普遍认为，用于缓解症状的药物可能会加速临终关怀患者的死亡。相反，临终关怀提供者的临床印象是，临终关怀可能会延长一些病人的生命。本研究探讨临终安养院与非临终安养院之末期病患存活期之差异。我们对五种癌症和充血性心力衰竭（CHF）患者的大型医疗保险受益人付费索赔数据库中选定的队列进行了回顾性统计分析。我们分析了1998-2002年从整个医疗保险受益人群的5%的样本中4493例患者的生存率，这些患者与6个狭义的指示性标志物相关。对于6个患者人群，临终关怀患者的平均生存期比非临终关怀患者长29天。CHF、肺癌、胰腺癌患者的平均生存期也显著延长，结肠癌患者的平均生存期略长（P = 0.08）。临终关怀与非临终关怀乳腺癌或前列腺癌患者的平均生存率无显著差异（统计学）。在所研究的各组中，临终关怀登记与较短的生存期没有显著相关性，但对于某些绝症患者，临终关怀与较长的生存时间相关。基于索赔的方法使用三年内死亡作为临床判断的替代品来推荐临终关怀，这意味着我们的研究结果适用于临床医生非常确定患者将在三年内死亡的情况，并且它指出需要验证这些发现。(C)2007年美国癌症疼痛缓解委员会。爱思唯尔公司出版All rights reserved.
There is a widespread belief by some health care providers and the wider community that medications used to alleviate symptoms may hasten death in hospice patients. Conversely, there is a clinical impression among hospice providers that hospice might extend some patients' lives. We studied the difference of survival periods of terminally ill patients between those using hospices and not using hospices. We performed retrospective statistical analysis on selected cohorts from large paid claim databases of Medicare beneficiaries for five types of cancer and congestive heart failure (CHF) patients. We analyzed the survival of 4493 patients from a sample of 5% of the entire Medicare beneficiary population for 1998-2002 associated with six narrowly defined indicative markers. For the six patient populations combined, the mean survival was 29 days longer for hospice patients than for nonhospice patients. The mean survival period was also significantly longer for the hospice patients with CHF, lung cancer, pancreatic cancer, and marginally significant for colon cancer (P = 0.08). Mean survival was not significantly different (statistically) for hospice vs. nonhospice patients with breast or prostate cancer. Across groups studied, hospice enrollment is not significantly associated with shorter survival, but for certain terminally ill patients, hospice is associated with longer survival times. The claims-based method used death within three years as a surrogate for a clinical judgment to recommend hospice, which means our findings apply to cases where a clinician is very sure the patient will die within three years, and it points to the need to validate these findings. (C) 2007 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.