Defining Serious Illness Among Adult Surgical Patients
Defining Serious Illness Among Adult Surgical Patients
复制标题
DOI：
10.1016/j.jpainsymman.2019.08.003
复制
发表时间：
2019-11-01
影响因子：
4.7
通讯作者：
Cooper, Zara
中科院分区：
文献类型：
--
作者：
Lee, Katherine C.;Walling, Anne M.;Cooper, Zara
上下文。对外科重病患者的姑息治疗（PC），包括使治疗与患者目标相一致和控制症状，与改善以患者为导向的结果和降低医疗保健利用率相关。然而，由于围手术期严重疾病缺乏共识的定义，将PC与恢复性手术护理结合起来的努力受到限制。本研究的目的是为外科患者制定一个严重疾病的定义，并确定质量测量工作的分母。我们制定了一个初步定义，包括11种条件和健康状态的一套标准。使用兰德-加州大学洛杉矶分校适当性方法，一个由12名成员组成的专家顾问小组对每个条件和健康状态的标准进行了两次评估，一次是在面对面的主持讨论之后，评估了有效性（主要结果）和测量结果的可行性。所有小组成员都完成了两轮评分。所有11个条件和健康状态定义严重疾病的手术患者被评为有效。在面对面的讨论中，小组成员完善和缩小了两种情况的标准（脆弱的老年人，心力衰竭）。最终定义包括以下11种状况和健康状态：易受伤害的老年人、心力衰竭、晚期癌症、氧依赖性肺病、肝硬化、终末期肾病、痴呆、严重创伤、虚弱、养老院居住和美国麻醉学会风险评分iv - v。我们确定了外科严重疾病的共识定义。机会仍然存在于测量患病率，确定健康轨迹，并制定筛查标准，将PC与恢复性手术护理相结合。(C) 2019年美国临终关怀与姑息医学学会。Elsevier Inc.出版。版权所有。
Context. Palliative care (PC) for seriously ill surgical patients, including aligning treatments with patients' goals and managing symptoms, is associated with improved patient-oriented outcomes and decreased health care utilization. However, efforts to integrate PC alongside restorative surgical care are limited by the lack of a consensus definition for serious illness in the perioperative context.Objectives. The objectives of this study were to develop a serious illness definition for surgical patients and identify a denominator for quality measurement efforts.Methods. We developed a preliminary definition including a set of criteria for 11 conditions and health states. Using the RAND-UCLA Appropriateness Method, a 12-member expert advisory panel rated the criteria for each condition and health state twice, once after an in-person moderated discussion, for validity (primary outcome) and feasibility of measurement.Results. All panelists completed both rounds of rating. All 11 conditions and health states defining serious illness for surgical patients were rated as valid. During the in-person discussion, panelists refined and narrowed criteria for two conditions (vulnerable elder, heart failure). The final definition included the following 11 conditions and health states: vulnerable elder, heart failure, advanced cancer, oxygen-dependent pulmonary disease, cirrhosis, end-stage renal disease, dementia, critical trauma, frailty, nursing home residency, and American Society of Anesthesiology Risk Score IV-V.Conclusion. We identified a consensus definition for serious illness in surgery. Opportunities remain in measuring the prevalence, identifying health trajectories, and developing screening criteria to integrate PC with restorative surgical care. (C) 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.