Significant Morbidity and Mortality Among Hospitalized End-Stage Liver Disease Patients in Medicare
Significant Morbidity and Mortality Among Hospitalized End-Stage Liver Disease Patients in Medicare
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DOI：
10.1016/j.jpainsymman.2016.03.013
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发表时间：
2016-09-01
影响因子：
4.7
通讯作者：
Muir, Andrew J.
中科院分区：
文献类型：
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作者：
Brown, Cristal L.;Hammill, Bradley G.;Muir, Andrew J.
上下文。对于终末期肝病(ESLD)患者，护理的重点是管理门静脉高压症的危及生命的并发症，导致资源利用率高。描述ESLD住院患者的临终轨迹。采用5%的随机抽样的医疗保险服务收费受益人，我们进行了一项回溯性队列研究，确定了2007-2011年住院的ESLD和心力衰竭(HF)患者。指标住院终点包括死亡率、出院到临终关怀院和住院时间。出院后终点包括全因死亡率、再住院、临终关怀登记人数和存活天数和出院天数(DAOH)。分别于指标入院后1年和3年进行随访。使用失代偿期心力衰竭患者的参考队列进行基线比较。在一年中，ESLD队列(n=22,311)有209个DAOH；失代偿期HF(n=85,397)有252个DAOH。在ESLD患者中，住院死亡率为13.5%，全因死亡率为64.9%。对于这些结果，患有ESLD的患者的发生率高于HF。在ESLD组，再住院率为59.1%(略低于HF组)，临终关怀入院率为36.1%，癌症发生率高于预期。对于登记了临终关怀的患者，在临终关怀中花费的时间中值为9天。HF组的临终关怀登记人数较低，但登记的天数较多。这项研究的结果表明，与ESLD的生命终结相关的发病率和死亡率是相当高的。迫切需要另一种方法来管理ESLD患者的护理。(C)2016年美国临终关怀与姑息医学学会。爱思唯尔公司出版，版权所有。
Context. For end-stage liver disease (ESLD) patients, care focuses on managing the life-threatening complications of portal hypertension, causing high resource utilization.Objectives. To describe the end-of-life trajectory of hospitalized ESLD patients in Medicare.Methods. Using a 5% random sample of Medicare fee-for-service beneficiaries, we performed a retrospective cohort study, identifying hospitalized ESLD and heart failure (HF) patients (2007-2011). Index hospitalization end points included mortality, discharge to hospice, and length of stay. Postdischarge end points included all-cause mortality, rehospitalization, hospice enrollment, and days alive and out of hospital (DAOH). Follow-up was at one and three years after index hospitalization discharge. A reference cohort of decompensated HF patients was used for baseline comparison.Results. At one year, the ESLD cohort (n = 22,311) had 209 DAOH; decompensated HF (n = 85,397) had 252 DAOH. Among ESLD patients, inpatient mortality was 13.5%; all-cause mortality was 64.9%. For these outcomes, rates were higher in those with ESLD than HF. In the ESLD group, rehospitalization rate was 59.1% (slightly lower than the HF group), hospice enrollment rate was 36.1%, and there were higher than expected cancer rates. For hospice-enrolled patients, the median length of time spent in hospice was nine days. The HF cohort had lower hospice enrollment, but more days enrolled.Conclusion. The results of this study show that morbidity and mortality rates associated with end of life in ESLD are substantial. There is an acute need for alternative approaches to manage the care of ESLD patients. (C) 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.