Impact of Palliative Care on Healthcare Utilization of Seriously Ill Older Adults

姑息治疗对重病老年人医疗保健利用的影响

• 批准号: 8516950
• 负责人: Laura Pilar Gelfman
• 金额: $ 8.01万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8516950
• 关键词: 18 year old; Address; Admission activity; Adult; Age; Aged, 80 and over; Caring; Cause of Death; Chronic Disease; Clinical; Cohort Studies; Comorbidity; Consultations; Cost Savings; Data; Data Analyses; Data Set; Databases; Diagnosis; Disease; Elderly; Elements; Enrollment; Expenditure; Future; Goals; Health Care Costs; Heart failure; Hospital Costs; Hospitalization; Hospitals; Incidence; Intensive Care Units; Intervention; Leadership; Length of Stay; Life; Malignant Neoplasms; Marketing; Medical; Medicare; Methods; Outcome; Pain; Palliative Care; Patients; Policies; Population; Quality of Care; Symptoms; Translating; United States; cohort; cost; experience; health care service utilization; hospice environment; human old age (65+); improved; meetings; mortality; older patient; outcome forecast; prospective; treatment as usual

DESCRIPTION (provided by applicant): Background: Heart failure (HF) is a chronic illness typically associated with multiple co-morbidities. Nearly 6 million people have HF, with the incidence approaching 1 in 100 adults over the age of 65. HF is the most common cause of hospitalization among adults over the age of 65 and admission rates for this disease have increased steadily over the last two decades. Even with current therapies, HF patients experience high symptom burden and mortality over the course of a prolonged and unpredictable illness. Symptomatic HF confers a worse prognosis than most cancers, with a one-year mortality of approximately 45 percent. Despite these numbers, less than 10% of patients with HF receive any form of palliative care; as of 2007, less than 12% of hospice admissions were patients with HF. Unlike the growing evidence of the benefits of palliative care for patients with cancer, there is a paucity of data regarding the potential benefit of an early palliative care intervention for older patients with HF. Palliative care has the potential to improe clinical outcomes for older patients facing HF by improving pain and other symptom control, clarifying goals of care, and guiding treatment decisions to meet goals. We hypothesize that these elements will translate into reduced healthcare utilization and cost. Objective: The goal of this proposal is to assess better the effect of palliative care consultation on utilization and coss of older adults with HF. Specific Aim 1: To compare the difference in healthcare utilization, including costs of hospitalization, length of stay, number of days in the intensive care unit (ICU) number of rehospitalizations and hospice enrollment at discharge among older patients with HF who received palliative care and those who received usual care. Specific Aim 2: To determine differences in healthcare utilization (as above) between younger (<65 years), older (65 to 84 years), and the oldest old (>85 years) patients with HF who received palliative care and those who received usual care. Methods: To address these aims, a secondary data analysis will be performed of the Palliative Care Leadership Center's (PCLC) Outcomes database, a unique database of hospital administrative and cost data from 8 geographically and structurally diverse hospitals representing low-, middle, and high-cost markets served by 6 palliative care consultation teams. The dataset includes hospital administrative data of patients aged 18 years or older with lengths of stay from 7 to 30 days between 2002 and 2004 who received palliative care and those who did not. Discussion: Data comparing the healthcare utilization of younger, older, and oldest old patients with HF will guide when palliative care will have the greatest benefit and direct policy efforts to improve quality of care and minimize healthcare cost. The results of this study will inform a future prospective cohort study comparing symptoms, survival and healthcare utilization for hospitalized older adults with HF who receive palliative care consultation with those who do not. This will create a better understanding of the benefits of palliative care to this population - a key first step in improving the quality of care for older adlts with HF.

描述（由申请人提供）： 背景：心力衰竭 (HF) 是一种通常与多种合并症相关的慢性疾病。近 600 万人患有心力衰竭，发病率接近 65 岁以上成年人中的百分之一。心力衰竭是 65 岁以上成年人住院的最常见原因，并且这种疾病的入院率在过去二十年中稳步上升。即使采用目前的治疗方法，心力衰竭患者在长期且不可预测的疾病过程中也会经历较高的症状负担和死亡率。有症状的心力衰竭比大多数癌症的预后更差，一年死亡率约为 45%。尽管有这些数字，但只有不到 10% 的心力衰竭患者接受任何形式的姑息治疗；截至 2007 年，入院临终关怀中心的心力衰竭患者不足 12%。与越来越多的证据表明姑息治疗对癌症患者的益处不同，有关早期姑息治疗干预对老年心力衰竭患者潜在益处的数据却很少。姑息治疗有可能通过改善疼痛和其他症状控制、明确护理目标并指导治疗决策以实现目标来改善面临心力衰竭的老年患者的临床结果。我们假设这些因素将转化为医疗保健利用率和成本的降低。目的：本提案的目的是更好地评估姑息治疗咨询对心力衰竭老年人的利用和费用的影响。具体目标 1：比较接受姑息治疗和接受常规护理的老年心力衰竭患者在医疗保健利用率方面的差异，包括住院费用、住院时间、重症监护病房 (ICU) 天数、再住院次数和出院时临终关怀登记情况。具体目标 2：确定接受姑息治疗和常规治疗的年轻（<65 岁）、老年（65 至 84 岁）和最高龄（>85 岁）心力衰竭患者之间医疗保健利用率（如上所述）的差异。方法：为了实现这些目标，将对姑息治疗领导中心 (PCLC) 的结果数据库进行二次数据分析，这是一个独特的数据库，包含来自 8 个地理位置和结构不同的医院的医院管理和成本数据，这些医院代表了由 6 个姑息治疗咨询团队服务的低、中和高成本市场。该数据集包括 2002 年至 2004 年间接受和未接受姑息治疗的 18 岁或以上、住院时间为 7 至 30 天的患者的医院管理数据。讨论：比较年轻、年长和年龄最大的心力衰竭患者的医疗保健利用率的数据将指导姑息治疗何时能带来最大的益处，并指导政策努力以提高护理质量并最大限度地降低医疗成本。这项研究的结果将为未来的一项前瞻性队列研究提供信息，该研究将接受姑息治疗咨询的心力衰竭住院老年人与未接受姑息治疗咨询的老年人的症状、生存率和医疗保健利用率进行比较。这将使人们更好地了解姑息治疗对这一人群的好处——这是提高老年心力衰竭患者护理质量的关键第一步。