Lackan Nuha A, Ostir Glenn V, Freeman Jean L, Mahnken Jonathan D, Goodwin James S
Sealy Center on Aging, the dagger Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas 77555-0460, USA.
Med Care. 2004 Feb;42(2):116-22. doi: 10.1097/01.mlr.0000108765.86294.1b.
Utilization of hospice services has been shown to vary by place of residence and patient characteristics.
The purpose of this study was to examine whether such variation has changed over time. Hospice utilization is examined as a function of sociodemographic characteristics, geographic location, type of insurance, and year of death.
This study used a retrospective cohort design.
We used data from the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database to study hospice utilization in subjects aged 67 and older diagnosed with breast, colorectal, lung, or prostate cancer from 1991 to 1996 and who died between 1991 and 1999.
Of the 170,136 subjects aged 67 and older who died from 1991 through 1999, 51,345 (30.2%) were enrolled in hospice before they died. Hospice utilization varied significantly by patient characteristics, including type of insurance, age, marital status, race and ethnicity, gender, urban versus rural residence, type of cancer, income level, and education level. This variation, however, decreased over time for subgroups defined by type of insurance, marital status, urban residence, and income. Variation in hospice use increased over time as a function of age and type of cancer. There was no change in variation in use in blacks compared with non-Hispanic whites over time.
The variation in hospice use by several patient characteristics is decreasing over time, a finding consistent with the manner in which new medical technologies diffuse.
临终关怀服务的使用情况已显示因居住地点和患者特征而异。
本研究的目的是检验这种差异是否随时间发生了变化。将临终关怀服务的使用情况作为社会人口统计学特征、地理位置、保险类型和死亡年份的函数进行考察。
本研究采用回顾性队列设计。
我们使用来自关联的监测、流行病学和最终结果（SEER）-医疗保险数据库的数据，研究1991年至1996年期间诊断为乳腺癌、结直肠癌、肺癌或前列腺癌且年龄在67岁及以上，并于1991年至1999年期间死亡的患者的临终关怀服务使用情况。
在1991年至1999年期间死亡的170,136名67岁及以上的患者中，有51,345名（30.2%）在死亡前登记接受了临终关怀服务。临终关怀服务的使用情况因患者特征而有显著差异，这些特征包括保险类型、年龄、婚姻状况、种族和族裔、性别、城乡居住情况、癌症类型、收入水平和教育水平。然而，对于按保险类型、婚姻状况、城市居住情况和收入定义的亚组，这种差异随时间减少。临终关怀服务使用的差异随年龄和癌症类型的变化而随时间增加。随着时间的推移，黑人与非西班牙裔白人在服务使用差异方面没有变化。
临终关怀服务使用情况在几个患者特征方面的差异随时间减少，这一发现与新医疗技术传播的方式一致。
