Variability in Access to Hospital Palliative Care in the United States
Variability in Access to Hospital Palliative Care in the United States
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DOI：
10.1089/jpm.2008.0053
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发表时间：
2008-10-01
影响因子：
2.8
通讯作者：
Morrison, R. Sean
中科院分区：
文献类型：
--
作者：
Goldsmith, Benjamin;Dietrich, Jessica;Morrison, R. Sean
背景：医院姑息治疗项目为重症患者及其家属提供高质量、全面的护理。目的：研究患者和医疗实习生获得医院姑息治疗的地理差异，并研究这些计划的预测因素。方法：对全国调查和人口普查资料进行一次和二次分析。包括医院姑息治疗项目在内的医院数据来自美国医院协会（AHA） 2006财政年度年度调查数据库（TM），并辅以邮寄调查。医学院附属医院的数据来源于美国医学院协会、网站综述和电话调查。医疗保健利用数据来自2008年达特茅斯医疗保健地图集。多变量逻辑回归用于确定与医院姑息治疗存在显著相关的特征。结果：共有52.8%的总床位在50张及以上的医院报告了医院姑息治疗，各州差异较大；40.9%（144/352）的公立医院、20.3%（84/413）的营利性医院和28.8%（160/554）的医疗保险单一社区提供者报告了医院姑息治疗。总共84.5%的医学院与至少一家医院的姑息治疗项目有关联。与医院姑息治疗显著相关（p < 0.05）的因素包括地理位置、拥有临终关怀计划、拥有美国外科学院批准的癌症计划、县内受过大学教育的人口百分比和医学院附属关系。与非营利机构相比，营利性和公立医院提供医院姑息治疗的可能性明显较低。观察到，医院姑息治疗普及率较高的州，医疗保险医院死亡人数较少，生命最后6个月内重症监护病房/心脏护理病房（ICU/CCU）天数和入院人数较少，晚期住院期间ICU/CCU入院人数较少，总体医疗保险支出/登记人数较低。讨论：这项研究代表了美国医院姑息治疗流行率的最新估计。尽管预测医院姑息治疗的因素自2005年以来没有改变，但在获得姑息治疗服务方面存在广泛的地理差异。总体而言，医学生获得医院姑息治疗的比例很高，尽管完全渗透到学术环境尚未发生。医院姑息治疗渗透和较低的医疗保险成本之间的关系是有趣的，值得进一步研究。
Background: Hospital palliative care programs provide high-quality, comprehensive care for seriously ill patients and their families.Objective: To examine geographic variation in patient and medical trainee access to hospital palliative care and to examine predictors of these programs.Methods: Primary and secondary analyses of national survey and census data. Hospital data including hospital palliative care programs were obtained from the American Hospital Association (AHA) Annual Survey Database (TM) for fiscal year 2006 supplemented by mailed surveys. Medical school-affiliated hospitals were obtained from the American Association of Medical Colleges, Web-site review, and telephone survey. Health care utilization data were obtained from the Dartmouth Atlas of Health Care 2008. Multivariate logistic regression was used to identify characteristics significantly associated with the presence of hospital palliative care.Results: A total of 52.8% of hospitals with 50 or more total facility beds reported hospital palliative care with considerable variation by state; 40.9% (144/352) of public hospitals, 20.3% (84/413) of for-profit hospitals, and 28.8% (160/554) of Medicare sole community providers reported hospital palliative care. A total of 84.5% of medical schools were associated with at least one hospital palliative care program. Factors significantly associated (p < 0.05) with hospital palliative care included geographic location, owning a hospice program, having an American College of Surgery approved cancer program, percent of persons in the county with a university education, and medical school affiliation. For-profit and public hospitals were significantly less likely to have hospital palliative care when compared with nonprofit institutions. States with higher hospital palliative care penetration rates were observed to have fewer Medicare hospital deaths, fewer intensive care unit/cardiac care unit (ICU/CCU) days and admissions during the last 6 months of life, fewer ICU/CCU admission during terminal hospitalizations, and lower overall Medicare spending/enrollee.Discussion: This study represents the most recent estimate to date of the prevalence of hospital palliative care in the United States. There is wide geographic variation in access to palliative care services although factors predicting hospital palliative care have not changed since 2005. Overall, medical students have high rates of access to hospital palliative care although complete penetration into academic settings has not occurred. The association between hospital palliative care penetration and lower Medicare costs is intriguing and deserving of further study.