Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009.
Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009.
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DOI：
10.1001/jama.2012.207624
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发表时间：
2013-02-06
影响因子：
120.7
通讯作者：
Mor, Vincent
中科院分区：
文献类型：
--
作者：
Teno, Joan M.;Gozalo, Pedro L.;Bynum, Julie P. W.;Leland, Natalie E.;Miller, Susan C.;Morden, Nancy E.;Scupp, Thomas;Goodman, David C.;Mor, Vincent
美国疾病控制与预防中心最近的一份报告发现，更多的人在家中死亡。这被认为是美国的临终者正在接受更多支持性护理的证据。描述 2000 年、2005 年和 2009 年之间死亡地点、护理地点和医疗保健转变的变化。对 20% 的按服务付费医疗保险受益人（年龄 66 岁及以上，死亡于 2000 年 (n=270 202)、2005 年 (n=291 819) 或 2009 年的随机 20% 样本进行回顾性队列研究） （n=286 282）。多变量回归模型在调整社会人口特征后检验了 2000 年和 2009 年的结果。根据账单数据，患者被分类为在生命最后 180 天内被诊断患有癌症、慢性阻塞性肺病或痴呆症。死亡地点、护理地点、医疗保健转换率以及可能带来负担的转换（例如，生命最后 3 天的医疗保健转换）。比较 2000 年、2005 年和 2009 年显示，急症护理医院的死亡人数有所减少，过去 30 天内重症监护病房 (ICU) 使用率、死亡时临终关怀中心的使用率以及生命末期的医疗保健转变有所增加（每种趋势检验 P < .001）。 2009 年，28.4%（95% CI，27.9%–28.5%）的临终关怀在死亡时使用的时间为 3 天或更短。在这些晚期临终关怀转诊中，40.3%（95% CI，39.7%–40.8%）在住院之前住进了 ICU。与 2000 年相比，2009 年和 2005 年死亡的医疗保险受益人中，死于急症护理医院的比例较低，尽管 ICU 使用率和医疗保健转换率在生命最后一个月有所增加。
A recent Centers for Disease Control and Prevention report found that more persons die at home. This has been cited as evidence that persons dying in the United States are using more supportive care. To describe changes in site of death, place of care, and health care transitions between 2000, 2005, and 2009. Retrospective cohort study of a random 20% sample of fee-for-service Medicare beneficiaries, aged 66 years and older, who died in 2000 (n=270 202), 2005 (n=291 819), or 2009 (n=286 282). A multivariable regression model examined outcomes in 2000 and 2009 after adjustment for sociodemographic characteristics. Based on billing data, patients were classified as having a medical diagnosis of cancer, chronic obstructive pulmonary disease, or dementia in the last 180 days of life. Site of death, place of care, rates of health care transitions, and potentially burdensome transitions (eg, health care transitions in the last 3 days of life). Comparing 2000, 2005, and 2009 shows a decrease in deaths in acute care hospitals and increases in intensive care unit (ICU) use in the last 30 days, hospice use at the time of death, and health care transitions at the end of the life (test of trend P < .001 for each). In 2009, 28.4% (95% CI, 27.9%–28.5%) of hospice use at the time of death was for 3 days or less. Of these late hospice referrals, 40.3% (95% CI, 39.7%–40.8%) were preceded by hospitalization with an ICU stay. Among Medicare beneficiaries who died in 2009 and 2005 compared with 2000, a lower proportion died in an acute care hospital, although both ICU use and the rate of health care transitions increased in the last month of life.
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影响因子：
2.2
作者：
Bakitas M;Lyons KD;Hegel MT;Balan S;Barnett KN;Brokaw FC;Byock IR;Hull JG;Li Z;McKinstry E;Seville JL;Ahles TA
通讯作者：
Ahles TA
影响因子：
4.7
作者：
Higginson, IJ;Finlay, I;Norman, CE
通讯作者：
Norman, CE
影响因子：
2.8
作者：
Higginson, I J;Sen-Gupta, G J
通讯作者：
Sen-Gupta, G J
影响因子：
2.8
作者：
Berke, Ethan M.;Smith, Tenbroeck;Goodman, David C.
通讯作者：
Goodman, David C.
影响因子：
2.8
作者：
Brody, Abraham Aizer;Ciemins, Elizabeth;Harrington, Charlene
通讯作者：
Harrington, Charlene