Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population?
Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population?
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DOI：
10.1089/jpm.2005.8.503
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发表时间：
2005-06-01
影响因子：
2.8
通讯作者：
Casarett, David
中科院分区：
文献类型：
--
作者：
Harrold, Joan;Rickerson, Elizabeth;Casarett, David
背景：临终关怀中心为具有广泛预后的患者提供护理，并且必须制定能够预测每个患者可能的疾病轨迹的护理计划。然而，可用于指导该人群的预测和护理计划的工具支持其使用的数据有限。例如，最广泛使用的预后工具之一，姑息性能量表（PPS），主要在住院患者和癌症患者中进行了研究。它在美国异质临终关怀人群中的预后价值尚不清楚。 目的：本研究的目的是评估 PPS 作为异质临终关怀人群死亡率预测因子的预后价值，并确定其在不同诊断和护理场所中的表现是否同样良好。设计：使用现有医疗记录进行前瞻性队列研究。背景/主题：本研究是在一个大型社区临终关怀计划中进行的，包括研究期间参加临终关怀的所有患者测量：在入组时记录每位患者的 PPS 评分，并对患者进行随访直至死亡或从临终关怀院出院。结果：研究期间共有 466 名患者入组临终关怀院。 PPS 评分是死亡率的强大独立预测因子（Kaplan Meier 生存曲线的对数秩检验 p < 0.001）。 3 个 PPS 类别的六个月死亡率分别为 96%（PPS 分数 10-20）、89%（PPS 分数 30-40）和 81%（PPS 分数 > 或 = 50）。 Cox 比例风险模型中交互项的评估表明，PPS 评分与疗养院居民和非癌症诊断患者的死亡率之间存在更强的关联。对接受者操作特征曲线下面积的分析显示出总体上很强的预测价值，对于疗养院居民和非癌症诊断患者的准确性更高。结论：PPS 在异质临终关怀人群中作为预后预测指标表现良好，对于疗养院居民和非癌症诊断患者表现尤其良好。 PPS 应有助于确认临终关怀报销资格并指导临终关怀计划。
BACKGROUND: Hospices provide care to patients with a wide range of prognoses, and must develop care plans that anticipate each patient's likely illness trajectory. However, the tools available to guide prognostication and care planning in this population have limited data to support their use. For instance, one of the most widely-used prognostic tools, the Palliative Performance Scale (PPS), has been studied primarily in inpatient settings and in patients with cancer. Its prognostic value in a heterogeneous US hospice population is unknown.OBJECTIVE: The goal of this study was to evaluate the prognostic value of the PPS as a predictor of mortality in a heterogeneous hospice population, and to determine whether it performs equally well across diagnoses and sites of care.DESIGN: Prospective cohort study using existing medical records.SETTING/SUBJECTS: This study was conducted at a large community hospice program, and included all patients enrolled in hospice during the study period.MEASUREMENTS: Each patient's PPS score was recorded at the time of enrollment and patients were followed until death or discharge from hospice.RESULTS: A total of 466 patients enrolled in hospice during the study period. The PPS score was a strong independent predictor of mortality (log rank test of Kaplan Meier survival curves p < 0.001). Six-month mortality rates for 3 PPS categories were 96% (for PPS scores 10-20), 89% (for PPS scores 30-40), and 81% (for PPS scores > or =50). Evaluation of interaction terms in Cox proportional hazards models demonstrated a stronger association between PPS score and mortality among nursing home residents and patients with non-cancer diagnoses. Analysis of the area under receiver operating characteristic curves demonstrated strong predictive value overall, with somewhat greater accuracy for nursing home residents and patients with noncancer diagnoses.CONCLUSION: The PPS performs well as a predictor of prognosis in a heterogeneous hospice population, and performs particularly well for nursing home residents and for patients with non-cancer diagnoses. The PPS should be useful in confirming hospice eligibility for reimbursement purposes and in guiding plans for hospice care.