Use of Palliative Care in Patients With End-Stage COPD and Receiving Home Oxygen National Trends and Barriers to Care in the United States
Use of Palliative Care in Patients With End-Stage COPD and Receiving Home Oxygen National Trends and Barriers to Care in the United States
复制标题
DOI：
10.1016/j.chest.2016.06.023
复制
发表时间：
2017-01-01
期刊：
影响因子：
9.6
通讯作者：
Celi, Leo Anthony
中科院分区：
文献类型：
--
作者：
Rush, Barret;Hertz, Paul;Celi, Leo Anthony
背景技术背景：调查姑息治疗（PC）的使用终末期COPD患者接受家庭氧气住院acquisition.METHODS：进行回顾性全国队列分析，使用全国范围内的住院患者样本。所有患者年龄≥ 18岁，诊断为COPD，接受家庭氧疗，并因急性加重而入院，均纳入研究。结果：2006-2012年全国住院患者样本中，共检查了55，208，382例住院患者。有181，689例COPD患者接受家庭氧疗，并因病情加重而入院; 3，145例患者（1.7%）也有PC接触。从2006年（0.45%）到2012年（2.56%），PC转诊相对增加了4.5倍（P <0.01）。接受PC咨询的患者与未接受PC咨询的患者相比年龄更大（75.0年[SD 10.9] vs 70.6年[SD 9.7]; P < .01），住院时间更长（4.9天[四分位数范围，2.6-8.2] vs 3.5天[四分位数范围，2.1-5.6]），更可能在医院死亡（32.1% vs 1.5%; P <0.01）。种族与转诊到姑息治疗显著相关，白色患者比少数民族患者更常转诊（P <0.01）。与PC转诊相关的因素包括年龄（OR，1.03; 95% CI，1.02-1.04; P < .01），转移性癌（OR，2.40; 95% CI，2.02-2.87; P < .01），非转移性癌症（OR，2.75; 95%CI，2.43-3.11; P < .01），有创机械通气（OR，4.89; 95%CI，4.31-5.55; P < .01），无创机械通气（OR，2.84; 95% CI，2.58-3.12; P < .01），和不复苏状态结论：在研究期间，PC的使用急剧增加;然而，PC接触仅发生在少数患有终末期COPD的急性加重患者中。
BACKGROUND: To investigate the use of palliative care (PC) in patients with end-stage COPD receiving home oxygen hospitalized for an exacerbation.METHODS: A retrospective nationwide cohort analysis was performed, using the Nationwide Inpatient Sample. All patients >= 18 years of age with a diagnosis of COPD, receiving home oxygen, and admitted for an exacerbation were included.RESULTS: A total of 55,208,382 hospitalizations from the 2006-2012 Nationwide Inpatient Sample were examined. There were 181,689 patients with COPD, receiving home oxygen, and admitted for an exacerbation; 3,145 patients (1.7%) also had a PC contact. There was a 4.5-fold relative increase in PC referral from 2006 (0.45%) to 2012 (2.56%) (P < .01). Patients receiving PC consultations compared with those who did not were older (75.0 years [SD 10.9] vs 70.6 years [SD 9.7]; P < .01), had longer hospitalizations (4.9 days [interquartile range, 2.6-8.2] vs 3.5 days [interquartile range, 2.1-5.6]), and more likely to die in hospital (32.1% vs 1.5%; P < .01). Race was significantly associated with referral to palliative care, with white patients referred more often than minorities (P < .01). Factors associated with PC referral included age (OR, 1.03; 95% CI, 1.02-1.04; P < .01), metastatic cancer (OR, 2.40; 95% CI, 2.02-2.87; P < .01), nonmetastatic cancer (OR, 2.75; 95% CI, 2.43-3.11; P < .01), invasive mechanical ventilation (OR, 4.89; 95% CI, 4.31-5.55; P < .01), noninvasive mechanical ventilation (OR, 2.84; 95% CI, 2.58-3.12; P < .01), and Do Not Resuscitate status (OR, 7.95; 95% CI, 7.29-8.67; P < .01).CONCLUSIONS: The use of PC increased dramatically during the study period; however, PC contact occurs only in a minority of patients with end-stage COPD admitted with an exacerbation.