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Understanding Access to Hospice Care

了解临终关怀的获取

基本信息

批准号：
7910583
负责人：
MELISSA Diane ALDRIDGE
金额：
$ 24.43万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-08-06 至 2012-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7910583
关键词：
Address Adopted Adverse effects Age Anxiety Area Automobile Driving Bereavement Caregiver Burden Caregivers Caring Categories Censuses Certificate of Need Certification Characteristics Chronic Disease Communities Community Outreach Computer software Counseling Country Data Dementia Disease Elderly Emotional Enrollment Ethnic Origin Family Foundations Future Geographic Locations Growth Health Services Healthcare Systems Heart Diseases Home environment Hospice Care Human Resources Incentives Income Individual Industry Information Technology Inpatients Institute of Medicine (U.S.)Interview Knowledge Life Life Expectancy Life Support Care Location Logistic Regressions Measures Medical Medicare Minority Minority Groups Modeling Monitor Pain Patient Care Patients Personal Satisfaction Policy Maker Population Process Provider Quality of Care Race Research Research Personnel Sampling Services Site Visit Social Work Solid Staging Stress Symptoms System Tax Equity and Fiscal Responsibility Act Taxonomy Techniques Terminal Disease Terminally Ill Time Training Training Activity United States Variant base beneficiary cancer diagnosis care preference career career development coping design experience hospice environment improved innovation meetings older patient palliative patient home care preference programs psychosocial racial and ethnic respite care satisfaction social socioeconomics symptom management volunteer

项目摘要

Three-quarters of individuals in the United States die from chronic illnesses,40 often after suffering both physically and psychologically for months or years.41 Recent evidence19-22 establishes the importance to patients and families coping with serious illness of receiving services across multiple domains that address the patient's physical, psychosocial and spiritual well-being, as well as the caregiver's well-being. However, the health care system has often failed to meet the needs of patients suffering from advanced illness and their families, who frequently experience inadequate pain and symptom management, 42-46 significant caregiver burden and stress,47,46 and overall dissatisfaction with care. Hospice was developed to address the multidimensional needs of patients suffering from serious illness and their families that were not being met by the traditional medical system. Hospice consists of services that focus on the physical, emotional, social, and spiritual needs of patients and their families including medical services, pain and symptom management, spiritual counseling, social services, and bereavement counseling. Services are palliative, rather than curative, and the majority of hospice care is provided in the patient's home.18 The population enrolled with hospice is rapidly diversifying as greater understanding of its benefits, particulariy for older adults with chronic illnesses, becomes wide-spread. Almost two-thirds of individuals enrolled with hospice are age 75 years or older.18 Individuals with a terminal diagnosis of cancer comprise 46% of all individuals enrolled with hospice, followed by those with end-stage heart disease (12%) and dementia (10%).18 The Tax Equity and Fiscal Responsibility Act of 1982 authorized Medicare to reimburse for hospice care under the Medicare Hospice Benefit (Table 1). In order for individuals to be eligible for hospice they must have a life expectancy of 6 months or less if the disease follows its usual course and must be willing to relinquish Medicare reimbursed services focused on life prolongation or cure. In order for hospices to receive reimbursement for hospice care they must be certified by Medicare.50 Medicare is the primary payor of hospice and approximately 94% 18 of hospices are Medicare certified. Certification requires satisfying several "conditions of participation 50 related to the availability of hospice services and the types of personnel that must be employed by the hospice. Reimbursement for hospice under Medicare is on a per diem basis according to four categories depending on the intensity of care delivered: routine home care, continuous home care (i.e., home care provided during periods of patient crisis), respite care (i.e., inpatient care for a short period to relieve the caregiver) and general inpatient care (i.e., inpatient care for patients unable to remain at home).51 More than 95% of hospice care reimbursed by Medicare is for routine home care.35

在美国，四分之三的人死于慢性疾病，40通常是在遭受数月或数年的身体和心理痛苦之后。41最近的证据19 -22确定了接受多个领域的服务对应对严重疾病的患者和家庭的重要性，这些服务涉及患者的身体、心理和精神健康以及护理人员的健康。然而，医疗保健系统往往无法满足晚期疾病患者及其家人的需求，他们经常遇到疼痛和症状管理不足、42-46严重的护理人员负担和压力、47、46以及对护理的总体不满。临终关怀的发展是为了解决传统医疗系统无法满足的严重疾病患者及其家人的多方面需求。临终关怀包括专注于患者及其家属的身体，情感，社会和精神需求的服务，包括医疗服务，疼痛和症状管理，精神咨询，社会服务和丧亲咨询。服务是姑息性的，而不是治疗性的，大多数临终关怀是在病人的家中提供的。18随着人们对临终关怀的好处，特别是对患有慢性病的老年人的好处的了解越来越多，参加临终关怀的人口正在迅速多样化。近三分之二的临终关怀患者年龄在75岁或以上。18癌症晚期诊断的患者占临终关怀患者的46%，其次是终末期心脏病患者（12%）和痴呆症患者（10%）。18 1982年的税收公平和财政责任法案授权医疗保险根据医疗保险临终关怀福利（表1）。为了使个人有资格获得临终关怀，他们必须有6个月或更短的预期寿命，如果疾病遵循其通常的过程，必须愿意放弃医疗保险报销的服务，重点是延长寿命或治愈。50医疗保险是临终关怀的主要支付者，大约94% 18的临终关怀是医疗保险认证的。认证要求满足几个“参与条件50有关的临终关怀服务的可用性和人员的类型，必须由临终关怀雇用。医疗保险下的临终关怀报销是按日计算的，根据提供的护理强度分为四类：常规家庭护理、持续家庭护理（即，在病人危机期间提供的家庭护理），喘息护理（即，短期住院护理以减轻护理者的负担）和普通住院护理（即，无法留在家中的病人的住院治疗）。医疗保险报销的临终关怀中，95%以上是常规家庭护理。