State Regulations and Hospice Utilization in Assisted Living During the Last Month of Life.
State Regulations and Hospice Utilization in Assisted Living During the Last Month of Life.
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DOI：
10.1016/j.jamda.2021.12.013
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发表时间：
2022-08
影响因子：
7.6
通讯作者：
Thomas, Kali S.
中科院分区：
文献类型：
--
作者：
Belanger, Emmanuelle;Teno, Joan M.;Wang, Xiao (Joyce);Rosendaal, Nicole;Gozalo, Pedro L.;Dosa, David;Thomas, Kali S.
旨在检查住院护理/辅助生活 (RC/AL) 中临终关怀/人员配置规定与临终关怀利用之间的关联，该群体是在生命最后一个月至少有一天居住在 RC/AL 的全国医疗保险死者队列，并描述临终关怀利用模式。对 2018 年死亡且在生命最后一个月内至少有一天居住在拥有 25 张以上床位的 RC/AL 社区的按服务付费医疗保险受益人进行的回顾性队列研究。 23,285 名死者在 6,274 个 RC/AL 社区度过了时光，拥有 146 个州执照分类。有关临终关怀服务使用的描述性统计数据；使用逻辑回归模型来测试支持临终关怀/注册护士 (RN) 人员配置要求的法规与 RC/AL 在生命最后一个月使用临终关怀的几率之间的关联。 56.4% 的研究队列在生命最后 30 天的某个时刻接受了 RC/AL 临终关怀护理，其中 5.7% 的人接受了更强化的持续家庭护理 (CHC)。居住在有支持性临终关怀政策的 RC/AL 中的死者中，有较大比例的人接受了临终关怀（57.3% 比 52.6%），这种差异是由更多的 CHC 临终关怀计划造成的。在控制了社会人口特征、合并症、花在 RC/AL 上的时间和医院转诊区域固定效应后，这种关联仍然显着。具有明确 RN 人员配置要求的 RC/AL 中的死者的 CHC 使用量显着减少（2.0% vs 6.8%）。无论规定如何，很大一部分 RC/AL 死者都在 RC/AL 接受临终关怀。那些在有明确支持临终关怀法规的许可环境中的人在生命最后一个月接受 RC/AL 临终关怀的可能性明显更大，尤其是 CHC 级别的临终关怀。尚未明确允许在 RC/AL 中进行临终关怀的州的监管变化可能会增加这种情况下临终关怀的利用率，尽管对护理质量的影响仍不清楚。在有支持性临终关怀法规的许可环境中，与居住在没有这些支持性法规的环境中的死者相比，在生命最后一个月内，临终关怀机构的利用率更高。
To examine the association between hospice/staffing regulations in residential care / assisted living (RC/AL) and hospice utilization among a national cohort of Medicare decedents residing in RC/AL at least one day during the last month of life, and to describe patterns of hospice utilization. Retrospective cohort study of fee-for-service Medicare beneficiaries who died in 2018 and resided in an RC/AL community with 25+ beds at least one day during the last month of life. 23,285 decedents who spent time in 6,274 RC/AL communities with 146 state license classifications. Descriptive statistics about hospice use; logistic regression models to test the association between regulations supportive of hospice care / registered nurse (RN) staffing requirements and the odds of hospice use in RC/AL in the last month of life. 56.4% of the study cohort received hospice care in RC/AL at some point during the last 30 days of life, including 5.7% who received more intensive continuous home care (CHC). A larger proportion of decedents who resided in RC/ALs with supportive hospice policies received hospice (57.3% vs 52.6%), with this difference driven by more CHC hospice programs. This association remained significant after controlling for sociodemographic characteristics, comorbidities, time spent in RC/AL and Hospital Referral Region fixed effects. Decedents in RC/ALs with explicit RN staffing requirements had significantly less CHC use (2.0% vs 6.8%). A large proportion of RC/AL decedents received hospice care in RC/AL regardless of differing regulations. Those in licensed settings with explicitly supportive hospice regulations were significantly more likely to receive hospice care in RC/AL during the last month of life, especially CHC level of hospice care. Regulatory change in states that do not yet explicitly allow hospice care in RC/AL may potentially increase hospice utilization in this setting, although the implications for quality of care remain unclear. Hospice utilization was higher during the last month of life among assisted living decedents in licensed settings with supportive hospice regulations, than those residing in settings without these supportive regulations.
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DOI：
10.1016/j.jamda.2019.09.013
发表时间：
2020-03
影响因子：
7.6
作者：
Thomas, Kali S.;Belanger, Emmanuelle;Zhang, Wenhan;Carder, Paula
通讯作者：
Carder, Paula
DOI：
10.1111/j.1532-5415.2007.01613.x
发表时间：
2008-04-01
影响因子：
6.3
作者：
Caprio, Anthony J.;Hanson, Laura C.;Zimmerman, Sheryl
通讯作者：
Zimmerman, Sheryl
影响因子：
5.7
作者：
Kaskie, Brian P.;Nattinger, Matthew;Potter, Andrew
通讯作者：
Potter, Andrew
影响因子：
6.3
作者：
Quigley, Denise D.;Parast, Layla;Anhang Price, Rebecca
通讯作者：
Anhang Price, Rebecca
影响因子：
6.3
作者：
Unroe, Kathleen T.;Stump, Timothy E.;Callahan, Christopher M.
通讯作者：
Callahan, Christopher M.