Association Between Hospice Length of Stay, Health Care Utilization, and Medicare Costs at the End of Life Among Patients Who Received Maintenance Hemodialysis
Association Between Hospice Length of Stay, Health Care Utilization, and Medicare Costs at the End of Life Among Patients Who Received Maintenance Hemodialysis
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DOI：
10.1001/jamainternmed.2018.0256
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发表时间：
2018-06-01
影响因子：
39
通讯作者：
O'Hare, Ann M.
中科院分区：
文献类型：
--
作者：
Wachterman, Melissa W.;Hailpern, Susan M.;O'Hare, Ann M.
重要性终末期肾脏疾病患者比其他晚期慢性疾病患者更不可能使用安宁疗护服务。在这一人群中，临终关怀转诊的时机及其与医疗保健利用和成本的关系尚不清楚。在接受维持性血液透析的医疗保险受益人中，研究临终关怀住院时间与医疗保健利用和临终费用之间的关系。设计、环境和参与者：本横断面观察性研究通过美国肾脏数据系统注册中心进行。参与者是登记在册的770191名血液透析患者，他们登记在2000年1月1日至2014年12月31日期间死亡。分析日期为2016年4月至2017年12月。在生命的最后一个月住院、重症监护病房（ICU）住院和接受强化手术；死在医院里；以及生命最后一周的医疗保险费用。结果770191例患者中，平均（SD）年龄为74.8（11.0）岁，男性53.7%。20%的队列成员在去世时正在接受临终关怀服务。其中，41.5%接受了3天或更短时间的临终关怀。在调整分析中，与未接受安宁疗护的患者相比，接受安宁疗护3天或更短时间的患者在医院死亡的可能性更低(13.5% vs 55.1%； P
IMPORTANCE Patients with end-stage renal disease are less likely to use hospice services than other patients with advanced chronic illness. Little is known about the timing of hospice referral in this population and its association with health care utilization and costs.OBJECTIVE. To examine the association between hospice length of stay and health care utilization and costs at the end of life among Medicare beneficiaries who had received maintenance hemodialysis.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional observational study was conducted via the United States Renal Data System registry. Participants were all 770 191 hemodialysis patients in the registry who were enrolled in fee-for-service Medicare and died between January 1, 2000, and December 31, 2014. The dates of analysis were April 2016 to December 2017.MAIN OUTCOMES AND MEASURES Hospital admission, intensive care unit (ICU) admission, and receipt of an intensive procedure during the last month of life; death in the hospital; and costs to the Medicare program in the last week of life.RESULTS Among 770 191 patients, the mean (SD) age was 74.8 (11.0) years, and 53.7% were male. Twenty percent of cohort members were receiving hospice services when they died. Of these, 41.5% received hospice for 3 days or fewer. In adjusted analyses, compared with patients who did not receive hospice, those enrolled in hospice for 3 days or fewer were less likely to die in the hospital (13.5% vs 55.1%; P