Disability and Decline in Physical Function Associated with Hospital Use at End of Life
Disability and Decline in Physical Function Associated with Hospital Use at End of Life
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DOI：
10.1007/s11606-012-2013-9
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发表时间：
2012-07-01
影响因子：
5.7
通讯作者：
Sarkisian, Catherine A.
中科院分区：
文献类型：
--
作者：
Kelley, Amy S.;Ettner, Susan L.;Sarkisian, Catherine A.
在临终前住院通常是患者不希望看到的，代表着相当大的医疗保险成本，而且在不同地区差异很大。为了同时检查与临终医院使用相关的地区和患者因素，包括残疾和功能衰退。我们从健康和退休研究(2000-2006)中抽样了65岁及以上的死者(n=2,493)，并从个人医疗保险报销和达特茅斯卫生保健地图集中关联数据。两部分回归模型估计了最近6个月的总住院天数与患者身体功能等特征的关系，同时调整了地区资源和医院护理强度(HCI)。中位住院天数为7天(范围为0-183)。53%的受访者有功能下降。与没有功能下降的死者相比，重度残疾或功能下降的患者有更多的回归调整住院天数(范围3.47-9.05，取决于类别)。痴呆症与较少的天数(-3.02)相关；而慢性肾脏疾病(2.37)、糖尿病(2.40)、中风或短暂性脑缺血发作(2.11)、充血性心力衰竭(1.74)与较多的天数相关。非洲裔美国人和西班牙裔美国人的天数更多(分别为5.91天和4.61天)。有家人在附近的人的天数减少了1.62天，临终关怀参与者的天数减少了1.88天。额外的住院天数与居住在城市(1.74)和居住在专科医生更多(1.97)和高HCI(2.27)的地区相关。功能衰退与老年人的临终住院显著相关。为了改善护理和降低成本，卫生保健计划和政策应该满足功能衰退和残疾患者的特定需求。
Hospital use near the end of life is often undesirable to patients, represents considerable Medicare cost, and varies widely across regions.To concurrently examine regional and patient factors, including disability and functional decline, associated with end-of-life hospital use.We sampled decedents aged 65 and older (n = 2,493) from the Health and Retirement Study (2000-2006), and linked data from individual Medicare claims and the Dartmouth Atlas of Health Care. Two-part regression models estimated the relationship between total hospital days in the last 6 months and patient characteristics including physical function, while adjusting for regional resources and hospital care intensity (HCI).Median hospital days was 7 (range = 0-183). 53% of respondents had functional decline. Compared with decedents without functional decline, those with severe disability or decline had more regression-adjusted hospital days (range 3.47-9.05, depending on category). Dementia was associated with fewer days (-3.02); while chronic kidney disease (2.37), diabetes (2.40), stroke or transient ischemic attack (2.11), and congestive heart failure (1.74) were associated with more days. African Americans and Hispanics had more days (5.91 and 4.61, respectively). Those with family nearby had 1.62 fewer days and hospice enrollees had 1.88 fewer days. Additional hospital days were associated with urban residence (1.74) and residence in a region with more specialists (1.97) and higher HCI (2.27).Functional decline is significantly associated with end-of-life hospital use among older adults. To improve care and reduce costs, health care programs and policies should address specific needs of patients with functional decline and disability.