Influence of Peer Physicians on Intensity of End-of-Life Care for Cancer Decedents.
Influence of Peer Physicians on Intensity of End-of-Life Care for Cancer Decedents.
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同行医生对癌症死者临终关怀强度的影响。
DOI：
10.1097/mlr.0000000000001124
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发表时间：
2019
期刊：
影响因子：
3
通讯作者：
Landon,BruceE
中科院分区：
文献类型：
--
作者：
Keating,NancyL;O'Malley,AlistairJames;Onnela,Jukka-Pekka;Gray,StacyW;Landon,BruceE
背景：临终关怀的强度在地区内和地区之间都有很大差异。不同的实践模式的个别医生很可能会受到他们的peer.Objective影响：评估是否强度的临终关怀以前提供的医生的peer.Research设计：观察性研究。Subjects：共185，947的收费服务医疗保险登记与癌症谁死在2006-2010年期间谁是由26，383名医生治疗。措施：支出在最后一个月的生活，> 1急诊室访问，> 1住院，重症监护病房入院在最后一个月的生活，化疗内2周死亡，没有/晚期临终关怀，终端住院。结果：生命最后一个月的平均（SD）支出为16,237美元（17,124美元）。前一年，同行医生的病人每增加1000美元的支出，自我医生的病人的支出就增加83美元（P< 0.001）。在有同行的医生中，更多的同行效应是由医生以外的实践（72美元增加每1000美元的同行医生的病人，P< 0.001）比同行的医生在实践（27美元，每1000美元增加的同行医生的病人，P= 0.01）。结果是类似的其他措施的临终关怀intensity.Conclusions：医生的同行施加影响的强度提供给医生的病人在生命的尽头。由有影响力的提供者和提供者组织领导的医生教育工作可能有潜力改善高价值临终关怀的提供。
Background:The intensity of end-of-life care varies substantially both within and between areas. Differing practice patterns of individual physicians are likely influenced by their peers.Objective:To assess whether intensity of end-of-life care previously provided by a physician’s peers influences patterns of care at the end-of-life for that physician’s patients.Research Design:Observational study.Subjects:A total of 185,947 fee-for-service Medicare enrollees with cancer who died during 2006–2010 who were treated by 26,383 physicians.Measures:Spending in the last month of life,> 1 emergency room visit,> 1 hospitalization, intensive care unit admission in the last month of life, chemotherapy within 2 weeks of death, no/late hospice, terminal hospitalization.Results:Mean (SD) spending in the last month of life was $16,237 ($17,124). For each additional $1000 of spending for a peer physician’s patients in the prior year, spending for the ego physician’s patients was $83 higher (P< 0.001). Among physicians with peers both in and out of their practice, more of the peer effect was explained by physicians outside of the practice ($72 increase for each $1000 increase by peer physicians’ patients, P< 0.001) than peer physicians in the practice ($27 for each $1000 increase by within-practice peer physicians’ patients, P= 0.01). Results were similar across the other measures of end-of-life care intensity.Conclusions:Physician’s peers exert influence on the intensity of care delivered to that physician’s patients at the end-of-life. Physician education efforts led by influential providers and provider organizations may have potential to improve the delivery of high-value end-of-life care.