Conceptualizing and Counting Discretionary Utilization in the Final 100 Days of Life: A Scoping Review.
Conceptualizing and Counting Discretionary Utilization in the Final 100 Days of Life: A Scoping Review.
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DOI：
10.1016/j.jpainsymman.2019.10.009
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发表时间：
2020-04
影响因子：
4.7
通讯作者：
Norton SA
中科院分区：
文献类型：
--
作者：
Duberstein PR;Chen M;Hoerger M;Epstein RM;Perry LM;Yilmaz S;Saeed F;Mohile SG;Norton SA
令人惊讶的是，很少有人注意到影响衡量生命终了时（DIALs）的自由裁量权使用的概念和方法问题，这是优质护理的一个指标。检查DIAL在操作上是如何定义的，并确定证据存在偏见或不足以告知实践的领域。我们对2004年1月1日至2017年6月30日发表的英语文献进行了范围审查。如果文章报告了≥18岁成人死亡后100天内≥2次DIAL的数据，则文章合格。我们探讨了研究设计对研究人员如何测量DIAL以及他们是否检查DIAL的人口统计学相关性的影响。其他潜在的偏见进行了探讨。我们从79种期刊上发表的254篇文章中提取了数据，这些文章涵盖了在29个国家进行的研究，主要是癌症（69.1%）。已经审查了100多个DIAL。相对粗糙、简单的变量（例如，ICU入院[56.9%的研究]，化疗[50.8%]，姑息治疗[40.0%]）比复杂变量（例如，过渡繁重; 7.3%）。我们发现DIAL的评估存在相当大的差异，说明了规范和纪律习惯的作用。变量的选择通常很少有来自公众（包括患者或护理人员）和临床医生的输入。不到一半的研究调查了DIAL的年龄（44.6%），性别（37.3%），种族（26.5%）或社会经济（18.5%）相关性。DIAL评估中的不必要变化引起了关于DIAL如何定义、由谁定义以及为什么定义的难题。我们推荐了几种改进DIAL评估的策略。公众、患者、护理人员、临床医生、研究人员、医院、卫生系统、付款人、政府和其他人可以使用改进的指标来评估和改善临终关怀。
There has been surprisingly little attention to conceptual and methodological issues that influence the measurement of discretionary utilization at the end-of-life (DIALs), an indicator of quality care. To examine how DIALs have been operationally defined, and identify areas where evidence is biased or inadequate to inform practice. We conducted a scoping review of the English language literature published from 1/1/04-6/30/17. Articles were eligible if they reported data on ≥2 DIALs within 100 days of the deaths of adults ≥18 years old. We explored the influence of research design on how researchers measure DIALs and whether they examine demographic correlates of DIALs. Other potential biases were explored. We extracted data from 254 articles published in 79 journals covering research conducted in 29 countries, mostly on cancer (69.1%). More than 100 DIALs have been examined. Relatively crude, simple variables (e.g., ICU admissions [56.9% of studies], chemotherapy [50.8%], palliative care [40.0%]) have been studied more frequently than complex variables (e.g., burdensome transitions; 7.3%). We found considerable variation in the assessment of DIALs, illustrating the role of norms and disciplinary habit. Variables are typically chosen with little input from the public (including patients or caregivers) and clinicians. Fewer than half the studies examined age (44.6%), gender (37.3%), race (26.5%), or socioeconomic (18.5%) correlates of DIALs. Unwarranted variation in DIALs assessments raises difficult questions concerning how DIALs are defined, by whom, and why. We recommend several strategies for improving DIALs assessments. Improved metrics could be used by the public, patients, caregivers, clinicians, researchers, hospitals, health systems, payers, governments, and others to evaluate and improve end-of-life care.
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影响因子：
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作者：
Bailey, FA;Burgio, KL;Goode, PS
通讯作者：
Goode, PS
影响因子：
2.6
作者：
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通讯作者：
Potapov, A.
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45.3
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通讯作者：
Ahles, Tim A.
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作者：
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通讯作者：
Patel, Bela
影响因子：
2.8
作者：
Amano, Koji;Morita, Tatsuya;Takagi, Ibuki
通讯作者：
Takagi, Ibuki