White Kenneth R, Cochran Clarke E, Patel Urvashi B
Graduate Program in Health Administration, Virginia Commonwealth University, Richmond 23298-0203, USA.
Med Care. 2002 Jan;40(1):17-25. doi: 10.1097/00005650-200201000-00004.
Availability of options other than aggressive medical treatment for persons with life-limiting illnesses has provided hospitals an opportunity to adopt formalized end-of-life care services.
To describe hospital ownership types that have adopted formalized end-of-life services (who), the scope of end-of-life services offered (what), and the geographic location of service provision (where).
Nationally representative cross-sectional data for 3,939 hospitals (80% of respondent hospitals) obtained from the American Hospital Association Annual Survey of Hospitals was used for the year 1998.
A scale was developed to measure hospital provision of general end-of-life, pain management, or hospice services. A multivariate ordinary least-squares regression model was used to test the association of ownership as a predictor of end-of-life service provision, while controlling for internal (organizational) and external (market location and size) characteristics.
Independent correlates of the number of end-of-life services provided include Catholic ownership, teaching status, number of staffed beds, and being located in a metropolitan statistical area or in New England. Forty-four percent of the sampled US hospitals provide none of the three end-of-life services included in this study. Another one third of hospitals provide only one of the three services.
Given the attention paid by both the general public and health professionals to pain relief and providing appropriate care to dying persons, such services are slow to be institutionalized in the hospital setting. The authors' findings suggest strategies for research and policy.
对于患有危及生命疾病的患者而言，除积极的医疗治疗之外，其他选择的可及性为医院提供了采用正规临终关怀服务的机会。
描述已采用正规临终关怀服务的医院所有制类型（哪些医院）、所提供临终关怀服务的范围（提供什么服务）以及服务提供的地理位置（在何处提供服务）。
采用1998年从美国医院协会年度医院调查中获取的3939家医院（占应答医院的80%）具有全国代表性的横断面数据。
开发了一个量表来衡量医院提供的一般临终关怀、疼痛管理或临终关怀服务。使用多元普通最小二乘回归模型来检验所有制作为临终关怀服务提供预测因素的相关性，同时控制内部（组织）和外部（市场位置和规模）特征。
所提供临终关怀服务数量的独立相关因素包括天主教所有制、教学地位、床位数量以及位于大都市统计区或新英格兰地区。在抽样的美国医院中，44%的医院未提供本研究中包含的三项临终关怀服务中的任何一项。另有三分之一的医院仅提供三项服务中的一项。
鉴于公众和卫生专业人员都关注缓解疼痛以及为临终患者提供适当护理，此类服务在医院环境中的制度化进程缓慢。作者的研究结果提出了研究和政策方面的策略。
