Palliative Care Consultation Trends Among Hospitalized Patients With Advanced Cancer in the United States, 2005 to 2014
Palliative Care Consultation Trends Among Hospitalized Patients With Advanced Cancer in the United States, 2005 to 2014
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DOI：
10.1177/1049909118809975
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发表时间：
2019-04-01
影响因子：
1.9
通讯作者：
Viamonte-Ros, Ana
中科院分区：
文献类型：
--
作者：
Rubens, Muni;Ramamoorthy, Venkataraghavan;Viamonte-Ros, Ana
背景：虽然美国的姑息治疗服务正在增加，但在获得和利用方面存在差距。因此，我们使用国家住院患者样本(NIS)对晚期癌症住院患者的这些因素进行了研究。方法：对NIS 2005年至2014年的数据进行了回顾分析，研究对象包括接受姑息治疗咨询和未接受姑息治疗咨询的18岁晚期癌症患者。分类变量和连续变量均采用卡方检验和独立t检验。多因素Logistic回归用于确定与姑息治疗咨询相关的因素。结果：在4732172例晚期癌症加权住院患者中，姑息治疗咨询的比例为9.9%，从2005年的3.0%上升到2014年的15.5%(相对增长，172.2%，P-趋势与t；01)。与较高的姑息治疗咨询相关的因素是年龄增加，&>=80岁(优势比[OR]：1.47；95%可信区间[CI]：1.38-1.56)；黑人种族(OR：1.21；95%CI：1.14-1.28)；私人保险覆盖范围(OR：1.10；95%CI：1.02-1.18)；西部地区(OR：1.15；95%CI：1.01-1.33)；大型医院(OR：1.19；95%CI：1.02~1.34)、高收入(OR：1.08；95%CI：1.08~1.17)、不复苏(OR：10.55；95%CI：10.14~10.99)、院内放疗(OR：1.13；95%CI：1.06~1.21)。接受化疗的患者姑息治疗咨询次数较少(OR：0.71；95%CI：0.60~0.84)。结论：在姑息治疗咨询中发现了许多人口、社会经济、医疗保健和地理差异。此外，晚期癌症住院患者没有充分利用姑息治疗资源，而濒临死亡的患者通常使用姑息治疗资源。卫生保健提供者和政策制定者应该关注这些差异，以改善姑息治疗的使用。
Background: Although palliative care services are increasing in the United States, disparities exist in access and utilization. Hence, we explored these factors in hospitalized patients with advanced cancers using the National Inpatient Sample (NIS). Methods: This was a retrospective analysis of NIS data, 2005 to 2014, and included patients >= 18 years with advanced cancers with and without palliative care consultations. Both chi(2) and independent t tests were used for categorical and continuous variables. Multivariate logistic regressions were used for identifying factors associated with palliative care consultations. Results: Palliative care consultations were recorded in 9.9% of 4 732 172 weighted advanced cancer hospitalizations and increased from 3.0% to 15.5% during 2005 to 2014 (relative increase, 172.2%, P-trend < .01). Factors associated with higher palliative care consultations were increasing age, >= 80 years (odds ratio [OR]: 1.47; 95% confidence interval [CI]: 1.38-1.56); black race (OR: 1.21; 95% CI: 1.14-1.28); private insurance coverage (OR: 1.10; 95% CI: 1.02-1.18); West region (OR: 1.15; 95% CI: 1.01-1.33); large hospitals (OR: 1.19; 95% CI: 1.02-1.34); high income (OR: 1.08; 95% CI: 1.08-1.17); do-not-resuscitate (dying patients) status (OR: 10.55; 95% CI: 10.14-10.99); and in-hospital radiotherapy (OR: 1.13; 95% CI: 1.06-1.21). Palliative care consultations were lower in patients with chemotherapy (OR: 0.71; 95% CI: 0.60-0.84). Conclusion: Many demographic, socioeconomic, health-care, and geographic disparities were identified in palliative care consultations. Additionally, palliative care resources were underutilized by hospitalized patients with advanced cancers and commonly utilized by patients who are dying. Health-care providers and policy makers should focus on these disparities in order to improve palliative care use.