Impact of Hospice Disenrollment on Health Care Use and Medicare Expenditures for Patients With Cancer
Impact of Hospice Disenrollment on Health Care Use and Medicare Expenditures for Patients With Cancer
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DOI：
10.1200/jco.2009.26.1818
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发表时间：
2010-10-01
影响因子：
45.3
通讯作者：
Bradley, Elizabeth H.
中科院分区：
文献类型：
--
作者：
Carlson, Melissa D. A.;Herrin, Jeph;Bradley, Elizabeth H.
目的癌症患者是安宁疗护使用者中最大的诊断群体，2008年有56万人转介安宁疗护。肿瘤学家依靠临终关怀团队为完成疾病指导治疗并希望留在家中的患者提供护理。然而，有11%至15%的安宁疗护使用者退出安宁疗护，而他们的医疗照护使用和医疗照护支出却鲜为人知。患者和方法我们使用1998年至2002年间因癌症死亡的临终关怀使用者的监测、流行病学和最终结果医疗保险数据（N = 90,826）来比较临终关怀退出者和临终关怀患者的住院率、急诊科率、重症监护病房入院率和住院死亡率。我们还比较了两组的每日医疗保险支出和总支出。结果癌症患者退出安宁疗护的住院率（39.8% v 1.6%, P < 0.001）、急诊科（33.9% v 3.1%, P < 001）或重症监护病房（5.7% v 0.1%, P < 001）和院内死亡率（9.6% v 0.2%, P < 001）较高。退出安宁疗护的病人在退出后的平均死亡时间为24天，表明退出安宁疗护的原因并不是健康状况的改善。在多变量分析中，安宁疗护退订者每天的医疗照护支出高于继续安宁疗护至死亡的患者（每日支出高出124美元；P < 001）。结论安宁疗护退出是医疗服务使用和医疗费用增加的标志。在安宁疗护取消登记后，管理病人照护和支持家庭照护者的策略可能是有益的，应该加以探讨。
PurposePatients with cancer represent the largest diagnostic group of hospice users, with 560,000 referred for hospice in 2008. Oncologists rely on hospice teams to provide care for patients who have completed disease-directed treatment and desire to remain at home. However, 11% to 15% of hospice users disenroll from hospice, and little is known about their health care use and Medicare expenditures.Patients and MethodsWe used Surveillance, Epidemiology and End Results-Medicare data for hospice users who died as a result of cancer between 1998 and 2002 (N = 90,826) to compare rates of hospitalization, emergency department, and intensive care unit admission and hospital death for hospice disenrollees and those who remained with hospice until death. We also compared per-day and total Medicare expenditures across the two groups.ResultsPatients with cancer who disenrolled from hospice were more likely to be hospitalized (39.8% v 1.6%; P < .001), more likely to be admitted to the emergency department (33.9% v 3.1%; P < 001) or intensive care unit (5.7% v 0.1%; P < 001), and more likely to die in the hospital (9.6% v 0.2%; P < 001). Patients who disenrolled from hospice died a median of 24 days following disenrollment, suggesting that the reason for hospice disenrollment was not improved health. In multivariable analyses, hospice disenrollees incurred higher per-day Medicare expenditures than patients who remained with hospice until death (higher per-day expenditures of $ 124; P < 001).ConclusionHospice disenrollment is a marker for higher health care use and expenditures for care. Strategies to manage a patient's care and support family caregivers following hospice disenrollment may be beneficial and should be explored.