Disparities in Inpatient Intensity of End-of-Life Care for Complex Chronic Conditions
Disparities in Inpatient Intensity of End-of-Life Care for Complex Chronic Conditions
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DOI：
10.1542/peds.2018-2228
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发表时间：
2019-05-01
期刊：
影响因子：
8
通讯作者：
Sanders, Lee
中科院分区：
文献类型：
--
作者：
Johnston, Emily E.;Bogetz, Jori;Sanders, Lee
这项加州行政数据库研究揭示了CCCs儿童住院临终关怀强度的比率、临床和社会经济差异。背景：患有复杂慢性病（CCC）的儿童需要不成比例的医疗保健服务，并且死亡率很高，但对他们的临终关怀知之甚少。方法：我们使用加州州行政数据库进行了一项基于人群的回顾性分析，该数据库包含2000年至2013年期间死于疾病相关原因的1至21岁CCC儿童。确定与先前定义的住院患者生命终末期强度指标相关的社会人口统计学和临床因素的发生率。强度指标包括：（1）住院死亡，（2）死亡后30天内接受过密集的医学干预（入住ICU、心肺复苏、血液透析和/或插管），以及（3）具有>= 2个强度标志物（包括住院死亡）。结果：研究人群中有8654名儿童，平均死亡年龄为11.8岁（SD 6.8）。最常见的3种CCC类别为神经肌肉（47%）、恶性肿瘤（43%）和心血管（42%）。66%的儿童在医院死亡，36%的儿童在生命的最后30天内接受了医学干预，35%的儿童有>= 2个强度标记。生活在低收入社区与医院死亡的几率增加，医疗干预强度和>= 2强度标记相关。西班牙裔和其他种族和/或民族与医院死亡和>= 2个强度标志物相关。年龄15至21岁与医院死亡，医学上密集的干预，和>= 2强度markers.CONCLUSIONS：社会人口学差异的强度与CCC儿童的临终关怀提高关注是否所有儿童都接受高质量和目标一致的临终关怀。
This California administrative database study reveals the rates of and clinical and socioeconomic disparities in inpatient end-of-life care intensity in children with CCCs. BACKGROUND:Children with complex chronic conditions (CCCs) require a disproportionate share of health care services and have high mortality rates, but little is known about their end-of-life care.METHODS:We performed a retrospective population-based analysis using a California State administrative database of children aged 1 to 21 years with a CCC who died of disease-related causes between 2000 and 2013. Rates of and sociodemographic and clinical factors associated with previously defined inpatient end-of-life intensity indicators were determined. The intensity indicators included: (1) hospital death, (2) receipt of a medically intense intervention within 30 days of death (ICU admission, cardiopulmonary resuscitation, hemodialysis, and/or intubation), and (3) having >= 2 intensity markers (including hospital death).RESULTS:There were 8654 children in the study population with a mean death age of 11.8 years (SD 6.8). The 3 most common CCC categories were neuromuscular (47%), malignancy (43%), and cardiovascular (42%). Sixty-six percent of the children died in the hospital, 36% had a medically intense intervention in the last 30 days of life, and 35% had >= 2 intensity markers. Living in a low-income neighborhood was associated with increased odds of hospital death, a medically intense intervention, and >= 2 intensity markers. Hispanic and other race and/or ethnicity were associated with hospital death and >= 2 intensity markers. Age 15 to 21 years was associated with hospital death, a medically intense intervention, and >= 2 intensity markers.CONCLUSIONS:Sociodemographic disparities in the intensity of end-of-life care for children with CCCs raise concerns about whether all children are receiving high-quality and goal-concordant end-of-life care.