Miller Susan C, Weitzen Sherry, Kinzbrunner Barrt
Center for Gerontology and Health Care Research, Brown University Medical School, Providence, Rhode Island 02912, USA.
J Palliat Med. 2003 Oct;6(5):725-36. doi: 10.1089/109662103322515239.
This study's goal was to gain an understanding of the factors associated with hospice stays of 7 days or less (i.e., short hospice stays), and to test the hypothesis that independent of changes in sociodemographics, diagnoses, and site-of-care, the likelihood of a short hospice stay increased over time. We examined hospice stays for 46655 nursing home and 80507 non-nursing home patients admitted between October 1994 and September 1999 to 21 hospices across 7 states, and owned by 1 provider. Logistic regression was used to determine the factors significantly associated with a higher probability of a short stay. Compared to patients admitted in (fiscal year) 1995, and controlling for potential confounders, the probability of a short stay significantly increased in each year after 1995 in nursing homes, and in 1999 in non-nursing home settings. In (fiscal year) 1995, a nursing home resident admitted to hospice had a 26% probability (95% confidence interval [CI] 0.24, 0.28) of a less than 8-day stay and, in (fiscal year) 1999, the probability was 33% (95% CI 0.31, 0.34); a non-nursing home patient had a 32% probability in 1995 (95% CI 0.30, 0.34) and a 36% probability in 1999 (95% CI 0.34, 0.37). The probability of a short hospice stay was greater for patients with noncancer diagnoses, independent of year of hospice admission. In this paper we discuss the possible underlying reasons for the increased probability of short hospice stays and we speculate on what this increase may mean in terms of hospice's ability to provide high-quality end-of-life care.
本研究的目的是了解与7天及以下临终关怀住院时间（即短期临终关怀住院）相关的因素，并检验以下假设：独立于社会人口统计学、诊断和护理地点的变化，短期临终关怀住院的可能性会随着时间的推移而增加。我们研究了1994年10月至1999年9月期间，7个州的21家由1家机构所有的临终关怀机构收治的46655名养老院患者和80507名非养老院患者的临终关怀住院情况。采用逻辑回归来确定与短期住院概率显著相关的因素。与1995年（财政年度）入院的患者相比，并控制潜在的混杂因素，1995年后各年养老院患者短期住院的概率显著增加，1999年非养老院患者短期住院的概率显著增加。1995年（财政年度），入住临终关怀机构的养老院居民住院时间少于8天的概率为26%（95%置信区间[CI]0.24,0.28），1999年（财政年度），这一概率为33%（95%CI0.31,0.34）；1995年非养老院患者的概率为32%（95%CI0.30,0.34），1999年为36%（95%CI0.34,0.37）。无论临终关怀入院年份如何，非癌症诊断患者短期临终关怀住院的概率更高。在本文中，我们讨论了短期临终关怀住院概率增加的可能潜在原因，并推测这种增加对临终关怀机构提供高质量临终护理能力的意义。
