Miller Susan C, Kiely Dan K, Teno Joan M, Connor Stephen R, Mitchell Susan L
Center for Gerontology & Health Care Research, Department of Community Health, The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
J Pain Symptom Manage. 2008 Mar;35(3):283-91. doi: 10.1016/j.jpainsymman.2007.12.001. Epub 2008 Jan 22.
Using the repository of 2005 Family Evaluation of Hospice Care data, this study examined whether bereaved family members report higher quality of care when hospices care for greater vs. lesser proportions of dementia patients. This organization-level analysis included 396 hospices meeting the study's eligibility criteria. Using hospice percentages of the "proportion of decedents with dementia," categories representing the lower three, the fourth and highest quintile values were created (i.e., <13%, > or =13%-19%, and > or =19%). Analyses were stratified by for-profit vs. not-for-profit because preliminary analyses showed differential associations by profit status. In for-profit hospices, hospices with the highest vs. lowest proportion of dementia patients (> or =19% vs. <13%) had significantly lower unmet pain needs (-1.7%, 95% confidence interval [CI] -3.1%, -0.2%). However, for both profit groups, caring for > or =19% dementia decedents (vs. <13%) was associated with a lower proportion of "excellent" care ratings (-2.3%, 95% CI -4.5%, -0.2%). Statistically significant associations between higher volume and better ratings were not observed for the remaining (six) outcomes, although this trend was found more among for-profit hospices. Thus, profit status appears to modify the association between volume of dementia care and care ratings. Further study is needed to understand the nonintuitive negative association between higher volume and lower satisfaction. This study emphasizes the need for examination of quality outcomes by profit status.
利用2005年临终关怀家庭评估数据储存库，本研究调查了在临终关怀机构照顾痴呆症患者比例较高与较低时，丧亲家庭成员报告的护理质量是否更高。这项机构层面的分析纳入了396家符合研究纳入标准的临终关怀机构。根据“痴呆症患者比例”的临终关怀百分比，创建了代表最低的三个、第四个和最高五分位数的值的类别（即<13%、≥13%-19%和≥19%）。分析按营利性与非营利性进行分层，因为初步分析显示了盈利状况的不同关联。在营利性临终关怀机构中，痴呆症患者比例最高与最低的临终关怀机构（≥19%与<13%）未满足的疼痛需求显著更低（-1.7%，95%置信区间[CI]-3.1%，-0.2%）。然而，对于两个盈利组，照顾≥19%的痴呆症死者（与<13%相比）与“优秀”护理评级比例较低相关（-2.3%，95%CI-4.5%，-0.2%）。对于其余（六个）结果，未观察到数量较多与评级较好之间的统计学显著关联，尽管这种趋势在营利性临终关怀机构中更常见。因此，盈利状况似乎改变了痴呆症护理数量与护理评级之间的关联。需要进一步研究以理解数量较多与满意度较低之间非直观的负相关。本研究强调了按盈利状况检查质量结果的必要性。
