Temporal Trends Between 2010 and 2015 in Intensity of Care at End-of-Life for Patients With Chronic Illness: Influence of Age Under vs. Over 65 Years
Temporal Trends Between 2010 and 2015 in Intensity of Care at End-of-Life for Patients With Chronic Illness: Influence of Age Under vs. Over 65 Years
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DOI：
10.1016/j.jpainsymman.2017.08.032
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发表时间：
2018-01-01
影响因子：
4.7
通讯作者：
Curtis, J. Randall
中科院分区：
文献类型：
--
作者：
Sathitratanacheewin, Seelwan;Engelberg, Ruth A.;Curtis, J. Randall
上下文最近对医疗保险数据的分析显示，随着时间的推移，临终关怀的强度有所下降。关于65岁以下老年人临终关怀强度趋势的研究很少。研究在大型医疗保健系统中接受治疗的慢性、限制生命诊断（≥ 65岁）的年龄分层死亡者的近期死亡时间趋势以及医院和重症监护室（ICU）利用率。使用死亡证明和电子健康记录对2010年至2015年期间死亡的22，068名慢性病患者进行回顾性队列研究。我们研究了整体利用和分层的年龄使用多元回归。2010年至2015年，在家中死亡的比例没有变化，但生命最后30天的住院率显著下降（医院B = -0.026; CI =-0.041，-0.012）。对于全样本和65岁或以上的患者，过去30天的ICU入院率也随着时间的推移而下降（总体B = -0.023; CI =-0.039，-0.007），但对于较年轻的死亡者则不显著。住院时间（LOS）并没有减少那些使用医院或ICU。从2010年到2015年，我们观察到所有年龄组的住院人数和65岁以上的ICU住院人数都有所减少。由于在过去30天内在家中或医院或ICU LOS中死亡的慢性病患者比例没有变化，因此在过去30天内住院和ICU入院可能是比死亡或LOS更敏感的姑息治疗干预质量指标。(C)2017年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
Context. Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65 years of age.Objectives. To examine recent temporal trends in place of death, and both hospital and intensive care unit (ICU) utilization, for age-stratified decedents with chronic, life-limiting diagnoses (= 65 years) who received care in a large healthcare system.Methods. Retrospective cohort using death certificates and electronic health records for 22,068 patients with chronic illnesses who died between 2010 and 2015. We examined utilization overall and stratified by age using multiple regression.Results. The proportion of deaths at home did not change, but hospital admissions in the last 30 days of life decreased significantly from 2010 to 2015 (hospital b = -0.026; CI = -0.041, -0.012). ICU admissions in the last 30 days also declined over time for the full sample and for patients aged 65 years or older (overall b = -0.023; CI = -0.039, -0.007), but was not significant for younger decedents. Length of stay (LOS) did not decrease for those using the hospital or ICU.Conclusion. From 2010 to 2015, we observed a decrease in hospital admissions for all age groups and in ICU admissions for those over 65 years. As there were no changes in the proportion of patients with chronic illness who died at home nor in hospital or ICU LOS in the last 30 days, hospital and ICU admissions in the last 30 days may be a more responsive quality metric than site of death or LOS for palliative care interventions. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.