Does hospital at home for palliative care facilitate death at home? Randomised controlled trial
Does hospital at home for palliative care facilitate death at home? Randomised controlled trial
复制标题
DOI：
10.1136/bmj.319.7223.1472
复制
发表时间：
1999-12-04
影响因子：
--
通讯作者：
Farquhar, MC
中科院分区：
文献类型：
--
作者：
Grande, GE;Todd, CJ;Farquhar, MC
目的评价居家医院姑息治疗服务对死亡地点的影响，设计实用随机对照试验，设置前剑桥卫生区，参与者229例转诊到居家医院服务的患者; 43例随机分配至对照组（标准护理），186例随机分配到家庭医院。家庭医院干预与标准治疗。主要结果测量死亡地点。结果25例（58%，对照组患者在家中死亡，而124例（67%）患者在家中住院。这种差异并不显著;意向治疗分析并未显示在家住院会增加在家死亡的人数。73例随机分配到家中医院的患者未接受该服务。在家中入院的患者在家中死亡的可能性显著高于对照组患者（88/113; 78%）。无法确定这是由于在家住院本身还是由于入院病人的其他特点。这项研究达到统计功率小于最初planned.Conclusion在一个地方提供良好的标准社区护理，我们不能表明，医院在家里允许更多的病人：死在家里，虽然也没有这项研究反驳这一点。与招募、流失和患者群体的脆弱性相关的问题使得姑息治疗的随机对照试验变得困难。虽然必须认识到这些困难，但只要有适当的资源和环境，它们并非不可克服。
Objective To evaluate the impact on place of death of a hospital at home service for palliative care.Design Pragmatic randomised controlled trial.Setting Former Cambridge health district.Participants 229 patients referred to the hospital at home service; 43 randomised to control group (standard care), 186 randomised to hospital at home.Intervention Hospital at home versus standard care.Main outcome measures Place of death.Results Twenty five (58%,) control patients died at home compared with 124 (67%) patients allocated to hospital at home. This difference was not significant; intention to treat analysis did not show that hospital at home increased the number of deaths at home. Seventy three patients randomised to hospital at home were not admitted to the service. Patients admitted to hospital at home were significantly more likely to die at home (88/113; 78%) than control patients. It is not possible to determine whether this was due to hospital at home itself or other characteristics of the patients admitted to the service. The study attained less statistical power than initially planned.Conclusion In a locality with good provision of standard community care we could not show that hospital at home allowed more patients: to die at home, although neither does the study refute this. Problems relating to recruitment, attrition, and the vulnerability of the patient group make randomised controlled trials in palliative care difficult While these difficulties have to be recognised they are not insurmountable with the appropriate resourcing and setting.