How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life.
How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life.
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DOI：
10.1111/jgs.14112
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发表时间：
2016-05
影响因子：
6.3
通讯作者：
M Fischer S
中科院分区：
文献类型：
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作者：
Matlock DD;Yamashita TE;Min SJ;Smith AK;Kelley AS;M Fischer S
我们的目的是比较美国医生和非医生在生命最后几个月的医疗保健利用率。基于广泛宣传的证词和假设的证据表明，医生希望在生命的最后阶段减少积极的护理，我们假设，与非医生相比，医生在生命的最后阶段会在医院度过更少的日子，在临终关怀中度过更多的日子。一项回顾性观察性队列研究。使用2008-2010年医疗保险A部分索赔数据的美国各地医疗保险受益人的服务费用，包括已故医生（N=9947）和医疗保险死者的随机样本（N= 192，006）。以住院天数和生命最后6个月内使用临终关怀的比例作为主要结局指标，并根据社会人口学特征和医疗保健的地区差异进行调整。住院病人的医院利用率在过去6个月的生活是没有不同的医生和非医生之间，虽然更多的医生使用临终关怀和更长的时间。调整协变量后，医生与其他人的比较如下：1）利用医院（OR=0.98，95%CI 0.93 ~ 1.04）; 2）住院天数（平均差异0.26，P=0.14）;（3）在医院死亡（OR=0.99，95% CI 0.95 - 1.04）4）ICU/CCU天数结果：（1）住院天数（平均差异2.06，P<0.001）;（2）住院天数（平均差异2.06，P <0.001）;（3）住院天数（平均差异2.06，P<0.001）;（4）住院天数（平均差异2.06，P<0.001）。这项回顾性、观察性研究受到编码实践中不可测量的混杂因素和变化的影响。然而，这项研究提供了实际利用的初步证据。美国医生更可能使用临终关怀和ICU/CCU级别的护理。住院率相似。
We aimed to compare health care utilization in the last months of life between physicians and non-physicians in the United States (US). Based on widely publicized testimonial and hypothetical evidence stating that physicians desire less aggressive care at the end of life, we hypothesized that physicians would spend fewer days in the hospital and more days in hospice at the end of life when compared to non-physicians. A retrospective observational cohort study. Fee-for-service Medicare beneficiaries across the United States using Medicare Part A claims data from 2008–2010 for decedent physicians (N=9947) and a random sample of Medicare decedents (N=192,006). Utilization measured by days in the hospital and proportion utilizing hospice in the last six months of life as primary outcome measures adjusted for sociodemographic characteristics and regional variations in health care. Inpatient hospital utilization in the last 6 months of life was no different between physicians and non-physicians, although more physicians used hospice and for longer. Comparisons of physicians to others, adjusting for covariates, were: 1) utilizing the hospital (OR=0.98, 95% CI 0.93 to 1.04); 2) hospital days (mean difference 0.26, P=0.14); 3) dying in the hospital (OR=0.99, 95% CI 0.95 to 1.04) 4) ICU/CCU days (mean difference 0.35 more days for physicians, P<0.001); 5) using hospice (OR=1.23, 95% CI 1.18 to 1.29); 6) number of days in hospice (mean difference 2.06 P<0.001). This retrospective, observational study is subject to unmeasured confounders and variation in coding practices. However, this study provides preliminary evidence of actual utilization. US Physicians were more likely to use hospice and ICU/CCU level care. Hospitalization rates were similar.