Podymow Tiina, Turnbull Jeffrey, Coyle Doug
University of Ottawa, Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada.
Palliat Med. 2006 Mar;20(2):81-6. doi: 10.1191/0269216306pm1103oa.
The homeless have high rates of mortality, but live in environments not conducive to terminal care. Traditional palliative care hospitals may be reluctant to accept such patients, due to behavior or lifestyle concerns. The Ottawa Inner City Health Project (OICHP) is a pilot study to improve health care delivery to homeless adults. This is a retrospective analysis of a cohort of terminally ill homeless individuals and the effectiveness of shelter-based palliative care. As proof of principle, a cost comparison was performed.
28 consecutive homeless terminally ill patients were admitted and died at a shelter-based palliative care hospice. Demographics, diagnoses at admission and course were recorded. Burden of illness was assessed by medical and psychiatric diagnoses, addictions, Karnofsky scale and symptom management. An expert panel was convened to identify alternate care locations. Using standard costing scales, direct versus alternate care costs were compared.
28 patients had a mean age 49 years; average length of stay 120 days. DIAGNOSES: liver disease 43%, HIV/AIDS 25%, malignancy 25% and other 8%. Addiction to drugs or alcohol and mental illness in 82% of patients. Karnofsky performance score mean 40 +/- 16.8. Pain management with continuous opiates in 71%. The majority reunited with family. Compared to alternate care locations, the hospice projected 1.39 million dollars savings for the patients described.
The homeless terminally ill have a heavy burden of disease including physical illness, psychiatric conditions and addictions. Shelter-based palliative care can provide effective end-of-life care to terminally ill homeless individuals at potentially substantial cost savings.
无家可归者死亡率很高，但生活在不利于临终关怀的环境中。由于对行为或生活方式的担忧，传统的姑息治疗医院可能不愿接收这类患者。渥太华市中心城区健康项目（OICHP）是一项旨在改善为无家可归成年人提供医疗服务的试点研究。这是一项对一组晚期无家可归患者以及基于收容所的姑息治疗效果的回顾性分析。作为原理验证，进行了成本比较。
28名连续入住并在一家基于收容所的姑息治疗临终关怀机构去世的晚期无家可归患者。记录了人口统计学信息、入院诊断和病程。通过医学和精神科诊断、成瘾情况、卡诺夫斯基量表以及症状管理来评估疾病负担。召集了一个专家小组来确定其他护理地点。使用标准成本核算量表，比较了直接护理成本与其他护理地点的成本。
28名患者的平均年龄为49岁；平均住院时间为120天。诊断情况：肝病43%，艾滋病毒/艾滋病25%，恶性肿瘤25%，其他8%。82%的患者存在药物或酒精成瘾以及精神疾病。卡诺夫斯基表现评分平均为40±16.8。71%的患者通过持续使用阿片类药物进行疼痛管理。大多数人与家人团聚。与其他护理地点相比，该临终关怀机构预计为所描述的患者节省139万美元。
晚期无家可归者疾病负担沉重，包括身体疾病、精神疾病和成瘾问题。基于收容所的姑息治疗可以为晚期无家可归患者提供有效的临终护理，同时可能大幅节省成本。
