Advance care planning and the quality of end-of-life care in older adults.
Advance care planning and the quality of end-of-life care in older adults.
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DOI：
10.1111/jgs.12105
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发表时间：
2013-02
影响因子：
6.3
通讯作者：
Smith AK
中科院分区：
文献类型：
--
作者：
Bischoff KE;Sudore R;Miao Y;Boscardin WJ;Smith AK
提前制定护理计划越来越普遍，但它是否会影响临终关怀质量仍存在争议。医疗保险数据和健康与退休研究的调查数据相结合，以确定提前护理计划是否与质量指标相关。全国代表性健康与退休研究。4394名死者（死亡时平均年龄82.6岁，55%为女性）。预先护理计划被定义为有预先指示、持久授权书或与近亲讨论过临终关怀的偏好。结果包括先前报道的生命最后一个月观察到的质量指标（住院率、住院死亡率、住院14天、重症监护病房入院率、急诊就诊率、临终关怀入院率和临终关怀时间≤3天）。76%的受试者参与了预先护理计划。92%的预先指示表示优先考虑舒适。调整后，参与预先护理计划的受试者在医院死亡的可能性较低（调整后RR 0.87, 95% CI 0.80-0.94），参加临终关怀的可能性较高（aRR 1.68, 1.43-1.97），在死亡前≤3天接受临终关怀的可能性较低（aRR 0.88, 0.85-0.91）。有预先指示、持久授权书或预先疗护计划讨论均与安宁疗护使用显著增加独立相关（均p<0.01）。预先的护理计划与生命末期护理质量的提高有关，包括减少院内死亡和增加临终关怀的使用。有一个预先指示，分配一个持久的授权书和进行预先护理计划的讨论都是预先护理计划的重要组成部分。
Advance care planning is increasingly common, but whether it influences end-of-life quality of care remains controversial. Medicare data and survey data from the Health and Retirement Study were combined to determine whether advance care planning was associated with quality metrics. The nationally representative Health and Retirement Study. 4394 decedent subjects (mean age 82.6 years at death, 55% women). Advance care planning was defined as having an advance directive, durable power of attorney or having discussed preferences for end-of-life care with a next-of-kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ≤3 days). Seventy-six percent of subjects engaged in advance care planning. Ninety-two percent of advance directives stated a preference to prioritize comfort. After adjustment, subjects who engaged in advance care planning were less likely to die in a hospital (adjusted RR 0.87, 95% CI 0.80-0.94), more likely to be enrolled in hospice (aRR 1.68, 1.43-1.97), and less likely to receive hospice for ≤3 days before death (aRR 0.88, 0.85-0.91). Having an advance directive, a durable-power-of-attorney or an advance care planning discussion were each independently associated with a significant increase in hospice use (p<0.01 for all). Advance care planning was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an advance directive, assigning a durable power of attorney and conducting advance care planning discussions are all important elements of advance care planning.
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影响因子：
--
作者：
Morrison, RS;Meier, DE
通讯作者：
Meier, DE
影响因子：
2.8
作者：
Briggs, Linda
通讯作者：
Briggs, Linda
DOI：
10.1177/1049909106292171
发表时间：
2006-10-01
期刊：
The American journal of hospice & palliative care
影响因子：
--
作者：
Collins, Lauren G;Parks, Susan M;Winter, Laraine
通讯作者：
Winter, Laraine
影响因子：
120.7
作者：
Teno, JM;Clarridge, BR;Mor, V
通讯作者：
Mor, V
影响因子：
45.3
作者：
Earle, Craig C.;Landrum, Mary Beth;Ayanian, John Z.
通讯作者：
Ayanian, John Z.