High Intensity of End-of-Life Care Among Adolescent and Young Adult Cancer Patients in the New York State Medicaid Program.
High Intensity of End-of-Life Care Among Adolescent and Young Adult Cancer Patients in the New York State Medicaid Program.
复制标题
DOI：
10.1097/mlr.0000000000000437
复制
发表时间：
2015-12
期刊：
影响因子：
3
通讯作者：
Schrag D
中科院分区：
文献类型：
--
作者：
Mack JW;Chen K;Boscoe FP;Gesten FC;Roohan PJ;Schymura MJ;Schrag D
对于青少年和青年癌症患者在生命末期（EOL）接受的护理，人们知之甚少。评估纽约州接受医疗补助的AYA癌症患者的强化措施和临终关怀的使用情况及死亡地点。使用来自纽约州癌症登记处和州医疗补助计划的相关患者水平数据，我们确定了2004-2011年间年龄在15至29岁之间被诊断患有癌症的705名医疗补助患者，这些患者随后死亡，并且在生命的最后60天内持续参加医疗补助计划。我们评估了强化EOL措施（死亡后14天内的化疗、重症监护室护理、bbb101急诊室就诊和生命最后30天的住院情况）、临终关怀的使用和死亡地点（住院临终关怀、长期护理机构、急性护理机构、有临终关怀的家庭、无临终关怀的家庭）的使用情况。75%的AYA医疗补助的死者至少使用了一个方面的强化EOL护理。38%的患者在生命的最后2周内接受了化疗；21%的人接受过重症监护病房治疗，44%的人在生命的最后一个月住院治疗。只有23%的人选择了临终关怀。65%的患者死于急性护理环境，包括住院医院或急诊室。鉴于AYA医疗补助计划参保者在EOL中采用强化措施的比率高，而临终关怀的利用率低，应优先考虑在这一高风险群体中最大化EOL护理质量的机会。
Little is known about the care that adolescent and young adult (AYA) cancer patients receive at the end-of-life (EOL). To evaluate use of intensive measures and hospice and location of death of AYA cancer patients insured by Medicaid in New York State. Using linked patient-level data from the New York state cancer registry and state Medicaid program, we identified 705 Medicaid patients who were diagnosed with cancer between the ages of 15 and 29 in the years 2004–2011, who subsequently died, and who were continuously enrolled in Medicaid in the last 60 days of life. We evaluated use of intensive EOL measures (chemotherapy within 14 days of death; intensive care unit care, >1 emergency room visit, and hospitalizations in the last 30 days of life), hospice use, and location of death (inpatient hospice, long-term care facility, acute care facility, home with hospice, home without hospice). 75% of AYA Medicaid decedents used at least one aspect of intensive EOL care. 38% received chemotherapy in the last 2 weeks of life; 21% received intensive care unit care, 44% had >1 emergency room visit, and 64% were hospitalized in the last month of life. Only 23% used hospice. 65% of patients died in acute care settings, including the inpatient hospital or emergency room. Given high rates of intensive measures and low utilization of hospice at the EOL among AYA Medicaid enrollees, opportunities to maximize the quality of EOL care in this high risk group should be prioritized.