Au David H, Udris Edmunds M, Fihn Stephan D, McDonell Mary B, Curtis J Randall
Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Wash, USA.
Arch Intern Med. 2006 Feb 13;166(3):326-31. doi: 10.1001/archinte.166.3.326.
We sought to examine health care resource utilization in the last 6 months of life among patients who died with chronic obstructive pulmonary disease (COPD) compared with those who died with lung cancer and to examine geographic variations in care.
We performed a retrospective cohort study of patients diagnosed as having COPD or lung cancer, who were seen in 1 of 7 Veteran Affairs medical centers primary care clinics and who died during the study period. Our outcome of interest was health care resource utilization in the last 6 months of life.
In the last 6 months of life, patients with COPD were more likely to visit their primary care providers but had fewer hospital admissions compared with patients with lung cancer. Patients with COPD had twice the odds of being admitted to an intensive care unit (ICU), 5 times the odds of remaining there 2 weeks or longer, and received fewer opiates and benzodiazepine prescriptions compared with patients with lung cancer. There were geographic variations in the use of ICUs for patients with COPD but not for those with lung cancer. Total health care costs were $4000 higher for patients with COPD because of ICU utilization.
In the last 6 months of life, patients with COPD were more likely to have had a primary care visit and been admitted to an ICU but less likely to receive palliative medications compared with patients with lung cancer. We found significant geographic variability in ICU utilization but only for patients with COPD.
我们试图研究慢性阻塞性肺疾病（COPD）死亡患者与肺癌死亡患者在生命最后6个月的医疗资源利用情况，并探讨医疗服务的地理差异。
我们对在7家退伍军人事务医疗中心之一的初级保健诊所就诊且在研究期间死亡的被诊断患有COPD或肺癌的患者进行了一项回顾性队列研究。我们感兴趣的结局是生命最后6个月的医疗资源利用情况。
在生命的最后6个月，与肺癌患者相比，COPD患者更有可能就诊于其初级保健医生，但住院次数较少。与肺癌患者相比，COPD患者入住重症监护病房（ICU）的几率高出两倍，在ICU停留2周或更长时间的几率高出5倍，且接受的阿片类药物和苯二氮䓬类药物处方较少。COPD患者在ICU使用方面存在地理差异，但肺癌患者不存在。由于ICU的使用，COPD患者的总医疗费用高出4000美元。
在生命的最后6个月，与肺癌患者相比，COPD患者更有可能进行初级保健就诊并入住ICU，但接受姑息治疗药物的可能性较小。我们发现ICU使用存在显著的地理差异，但仅存在于COPD患者中。
