O'Mahony Sean, Blank Arthur E, Zallman Leah, Selwyn Peter A
Palliative Care Service, Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA.
J Palliat Med. 2005 Oct;8(5):1033-9. doi: 10.1089/jpm.2005.8.1033.
This report describes the multiple complementary analytic methods used to create a composite evaluation of the benefits of a hospital-based inpatient palliative care consultation service at Montefiore Medical Center in its preliminary phase. We evaluated data regarding 592 consecutive patients consulted by the palliative care service between November 2000, through March 2002. Standardized medical record reviews indicated that over 90% of interventions recommended by the palliative care team were accepted and acted on by the primary team; audit of the medical records of 368 patients confirmed that pain and other symptoms improved in 87% of patients after palliative care intervention. Ninety-five percent of respondents to a telephone survey of family caregivers described themselves as likely to recommend the service to others. High levels of referring provider satisfaction were evidenced by a Likert- scale provider satisfaction survey and an increase in the rate of referral for palliative care consultation from 2% to 21% of all patients dying at our medical center during the study period. There were also significant reductions in charges for ancillary tests and ventilator charges after palliative care consultation. A matched case control study of mechanically ventilated patients demonstrated significant savings in hospital charges (n = 160 pairs). Length of stay was significantly reduced for patients referred for hospice (n = 112). This type of multifaceted approach is necessary for the evaluation of a service with multiple components that would be difficult to capture with a single analytic approach. This report suggests efficacy of our palliative care service in terms of patient outcomes, provider satisfaction, caregiver satisfaction, and cost savings.
本报告描述了在蒙特菲奥里医疗中心初步阶段用于对基于医院的住院姑息治疗咨询服务的益处进行综合评估的多种互补分析方法。我们评估了2000年11月至2002年3月期间姑息治疗服务连续咨询的592例患者的数据。标准化病历审查表明，姑息治疗团队推荐的超过90%的干预措施被主要团队接受并付诸行动；对368例患者的病历审核证实，姑息治疗干预后87%的患者疼痛和其他症状有所改善。对家庭护理人员进行的电话调查中，95%的受访者表示可能会向他人推荐该服务。李克特量表提供者满意度调查以及在研究期间我们医疗中心所有死亡患者中姑息治疗咨询转诊率从2%提高到21%，都证明了转诊提供者的高度满意度。姑息治疗咨询后，辅助检查费用和呼吸机费用也有显著降低。一项对机械通气患者的配对病例对照研究表明，医院费用大幅节省（n = 160对）。转诊至临终关怀的患者住院时间显著缩短（n = 112）。对于评估具有多个组成部分且难以用单一分析方法捕捉的服务而言，这种多方面的方法是必要的。本报告表明我们的姑息治疗服务在患者预后、提供者满意度、护理人员满意度和成本节约方面具有有效性。
