Trends in hospital utilization and outcome for patients with ALS
Trends in hospital utilization and outcome for patients with ALS
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ALS 患者的医院利用率和结果趋势
作者：
R. Dubinsky;Jeffrey Chen;S. Lai
目的：研究美国一个大型队列中ALS患者的住院死亡率、利用率和护理趋势。方法：作者使用1988年至2002年的全国住院患者样本进行了回顾性队列比较。他们使用ICD-9编码识别入院、合并症和手术。结果包括入院原因，费用（调整到2002年美元），住院时间，出院处置，和利用临终关怀。显著性先验设定为p < 0.001。结果：他们识别了17，249条记录。重要的发现是，随着时间的推移，（肺炎[38.1%至47.3%]、呼吸衰竭[26.9%至35.5%]和营养缺乏[43.0%至56.3%]）;中位住院时间从6天下降到4天;平均住院费用从21，574美元增加到24，314美元;医院死亡的比例随着时间的推移而下降（从17.6%下降到14.6%），而出院到家庭保健/临终关怀机构（从14.0%下降到18.2%）和长期护理机构（从13.2%上升到27.9%）的比例则有所增加。因呼吸衰竭入院的患者死亡的优势比（OR）为5.03（95%CI：4.57 ~ 5.54），肺炎患者为1.36（1.24 ~ 1.50），营养缺乏患者为0.84（0.77 ~ 0.92）。结论：因肺炎或呼吸衰竭入院的患者死亡的高OR可能与更晚期的疾病相关，而因营养缺乏入院的保护作用与延髓症状的优势和疾病早期入院一致。在这15年的管理数据集的趋势是增加合并症和更高的利用临终关怀。
Objective: To examine hospital mortality, utilization, and trends in care of patients with ALS in a large U.S. cohort. Methods: The authors performed a retrospective cohort comparison, using the Nationwide Inpatient Sample for 1988 to 2002. They identified admissions, comorbidities, and procedures using ICD-9 codes. Outcomes included reason for admission, cost (adjusted to 2002 dollars), length of stay, discharge disposition, and utilization of hospice care. Significance was set a priori at p < 0.001. Results: They identified 17,249 records. The significant findings were that common morbidities increased over time (pneumonia [38.1% to 47.3%], respiratory failure [26.9% to 35.5%], and nutritional deficiency [43.0% to 56.3%]); the median length of stay dropped from 6 to 4 days; mean hospital charges increased from $21,574 to $24,314; the proportion of hospital deaths decreased over time (17.6% to 14.6%), whereas the proportion discharged to home health/hospice care (14.0% to 18.2%) and to long-term care facilities (13.2% to 27.9%) increased. The odds ratio (OR) of death was 5.03 (95% CI: 4.57 to 5.54) for those admitted with respiratory failure, 1.36 (1.24 to 1.50) for those with pneumonia, and 0.84 (0.77 to 0.92) for those with nutritional deficiency. Conclusion: The high OR of death in patients admitted for pneumonia or respiratory failure is likely associated with more advanced disease, whereas the protective effect of admission for nutritional deficiency is consistent with the predominance of bulbar symptoms and admission earlier in the disease. The trends during the 15 years of this administrative data set were for increasing comorbidities and higher utilization of end-of-life care.