Increased Access to Palliative Care and Hospice Services: Opportunities to Improve Value in Health Care
Increased Access to Palliative Care and Hospice Services: Opportunities to Improve Value in Health Care
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DOI：
10.1111/j.1468-0009.2011.00632.x
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发表时间：
2011-09-01
影响因子：
6.6
通讯作者：
Meier, Diane E.
中科院分区：
文献类型：
--
作者：
Meier, Diane E.
背景：一小部分患有严重疾病或多种慢性病的患者占医疗保健支出的大部分。尽管成本高昂，但有证据表明，这些患者接受的医疗保健质量不足，其特点是分散、过度使用、医疗错误和生活质量差。方法：本文研究的数据显示了美国医疗保健系统对病情最严重和最脆弱患者的临床护理结果和费用的影响。它还定义了姑息治疗和临终关怀，综合了姑息治疗和临终关怀服务结果的研究，审查了预测获得姑息治疗和临终关怀服务的变量，并确定了加强获得高质量姑息治疗所必需的政策优先事项。研究结果：姑息治疗和临终关怀服务改善了以患者为中心的结果，如疼痛、抑郁和其他症状；患者及家属满意度；以及在患者选择的地点接受护理。一些数据表明，与常规护理相比，姑息治疗可以延长生命。通过帮助患者获得所需的护理，避免不必要的急诊科和住院治疗，并将护理地点转移到家庭或社区，姑息治疗和临终关怀减少了美国病情最严重、费用最高的患者群体的医疗保健支出。结论：需要制定政策，重点加强姑息治疗劳动力、投资该领域的科学基础以及增加美国医院和疗养院的服务可用性，以确保重病患者和多发性硬化症患者公平获得最佳护理。慢性病。
Context: A small proportion of patients with serious illness or multiple chronic conditions account for the majority of health care spending. Despite the high cost, evidence demonstrates that these patients receive health care of inadequate quality, characterized by fragmentation, overuse, medical errors, and poor quality of life.Methods: This article examines data demonstrating the impact of the U.S. health care system on clinical care outcomes and costs for the sickest and most vulnerable patients. It also defines palliative care and hospice, synthesizes studies of the outcomes of palliative care and hospice services, reviews variables predicting access to palliative care and hospice services, and identifies those policy priorities necessary to strengthen access to high-quality palliative care.Findings: Palliative care and hospice services improve patient-centered outcomes such as pain, depression, and other symptoms; patient and family satisfaction; and the receipt of care in the place that the patient chooses. Some data suggest that, compared with the usual care, palliative care prolongs life. By helping patients get the care they need to avoid unnecessary emergency department and hospital stays and shifting the locus of care to the home or community, palliative care and hospice reduce health care spending for America's sickest and most costly patient populations.Conclusions: Policies focused on enhancing the palliative care workforce, investing in the field's science base, and increasing the availability of services in U. S. hospitals and nursing homes are needed to ensure equitable access to optimal care for seriously ill patients and those with multiple chronic conditions.