Improving the use of hospice services in nursing homes - A randomized controlled trial
Improving the use of hospice services in nursing homes - A randomized controlled trial
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DOI：
10.1001/jama.294.2.211
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发表时间：
2005-07-13
影响因子：
120.7
通讯作者：
Asch, DA
中科院分区：
文献类型：
--
作者：
Casarett, D;Karlawish, J;Asch, DA
背景临终关怀可以提高临终关怀护理的质量为养老院居民，但临终关怀是利用不足的这一人群，至少部分是因为医生不知道他们的patients.Objective确定是否有可能增加临终关怀利用和提高临终关怀质量的居民的目标和偏好是一致的临终关怀。设计，设置，和参与者随机对照试验（2003年12月至2004年12月）的疗养院居民和他们的代理决策者（N=205）在3美国nursinghomes.Intervention结构化访谈确定居民的目标，护理，治疗偏好，姑息治疗的需要，使他们适合临终关怀。主要结果指标主要结果指标是（1）干预后30天内的临终关怀登记和（2）在6个月随访期间死亡的居民的家庭对护理质量的评价。107人被随机分配接受干预，98人接受常规护理。干预居民比普通护理居民更有可能在30天内参加临终关怀（21/107 [20%] vs 1/98 [1%]; P
Context Hospice care may improve the quality of end-of-life care for nursing home residents, but hospice is underutilized by this population, at least in part because physicians are not aware of their patients' preferences.Objective To determine whether it is possible to increase hospice utilization and improve the quality of end-of-life care by identifying residents whose goals and preferences are consistent with hospice care.Design, Setting, and Participants Randomized controlled trial (December 2003-December 2004) of nursing home residents and their surrogate decision makers (N=205) in 3 US nursing homes.Intervention A structured interview identified residents whose goals for care, treatment preferences, and palliative care needs made them appropriate for hospice care. These residents' physicians were notified and asked to authorize a hospice informational visit.Main Outcome Measures The primary outcome measures were (1) hospice enrollment within 30 days of the intervention and (2) families' ratings of the quality of care for residents who died during the 6-month follow-up period.Results Of the 205 residents in the study sample, 107 were randomly assigned to receive the intervention, and 98 received usual care. Intervention residents were more likely than usual care residents to enroll in hospice within 30 days (21/107 [20%] vs 1/98 [1%]; P