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

描述(申请人提供)：背景：心力衰竭(HF)是一种慢性疾病，通常与多种并存疾病有关。近600万人患有心力衰竭，发病率接近每100名65岁以上的成年人中就有一人。心力衰竭是65岁以上成年人住院的最常见原因，在过去20年中，这种疾病的住院率稳步上升。即使使用目前的治疗方法，心力衰竭患者在长期和不可预测的疾病过程中也会经历高症状负担和死亡率。与大多数癌症相比，有症状的心衰预后更差，一年死亡率约为45%。尽管有这些数字，只有不到10%的心力衰竭患者接受了任何形式的姑息治疗；截至2007年，只有不到12%的临终关怀住院患者是心力衰竭患者。与越来越多的证据表明姑息治疗对癌症患者的益处不同，关于早期姑息治疗干预对老年心力衰竭患者的潜在好处的数据很少。姑息治疗通过改善疼痛和其他症状控制，明确护理目标，并指导治疗决定以达到目标，有可能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：本建议的目的是更好地评估姑息治疗咨询对老年心力衰竭患者的利用率和COSS的影响。具体目标1：比较接受姑息治疗的老年心衰患者和接受常规护理的老年心衰患者在医疗利用方面的差异，包括住院费用、住院时间、在重症监护病房(ICU)的天数、再住院次数和出院时的临终关怀登记人数。具体目标2：确定接受姑息治疗的年轻(65岁)、老年(65岁至84岁)和最年长(85岁)心力衰竭患者与接受常规护理的患者在医疗利用方面的差异(如上)。方法：为了达到这些目标，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，其中包括来自8家地理和结构不同的医院的医院管理和成本数据，这些医院代表着由6个姑息治疗咨询团队服务的低、中、高成本市场。该数据集包括2002年至2004年期间接受姑息治疗的18岁或18岁以上、住院时间从7天到30天的患者以及没有接受姑息治疗的患者的医院管理数据。讨论：比较年轻、老年和老年心力衰竭患者的医疗保健利用情况的数据将指导姑息治疗何时具有最大的益处，并指导政策努力，以提高护理质量和最大限度地降低医疗成本。这项研究的结果将为未来的前瞻性队列研究提供信息，比较接受姑息治疗咨询的住院心力衰竭老年患者和没有接受姑息治疗咨询的患者的症状、存活率和医疗利用情况。这将使人们更好地了解姑息治疗对这一人群的好处--这是改善老年心力衰竭患者护理质量的关键第一步。

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.