Gade Glenn, Venohr Ingrid, Conner Douglas, McGrady Kathleen, Beane Jeffrey, Richardson Robert H, Williams Marilyn P, Liberson Marcia, Blum Mark, Della Penna Richard
Department of Internal Medicine, Denver, Colorado, USA.
J Palliat Med. 2008 Mar;11(2):180-90. doi: 10.1089/jpm.2007.0055.
Palliative care improves care and reduces costs for hospitalized patients with life-limiting illnesses. There have been no multicenter randomized trials examining impact on patient satisfaction, clinical outcomes, and subsequent health care costs.
Measure the impact of an interdisciplinary palliative care service (IPCS) on patient satisfaction, clinical outcomes, and cost of care for 6 months posthospital discharge.
Multicenter, randomized, controlled trial. IPCS provided consultative, interdisciplinary, palliative care to intervention patients. Controls received usual hospital care (UC).
Five hundred seventeen patients with life-limiting illnesses from a hospital in Denver, Portland, and San Francisco enrolled June 2002 to December 2003.
Modified City of Hope Patient Questionnaire, total health care costs, hospice utilization, and survival.
IPCS reported higher scores for the Care Experience scale (IPCS: 6.9 versus UC: 6.6, p = 0.04) and for the Doctors, Nurses/Other Care Providers Communication scale (IPCS: 8.3 versus UC: 7.5, p = 0.0004). IPCS patients had fewer intensive care admissions (ICU) on hospital readmission (12 versus 21, p = 0.04), and lower 6-month net cost savings of $4,855 per patient (p = 0.001). IPCS had longer median hospice stays (24 days versus 12 days, p = 0.04). There were no differences in survival or symptom control.
IPCS patients reported greater satisfaction with their care experience and providers' communication, had fewer ICU admissions on readmission, and lower total health care costs following hospital discharge.
姑息治疗可改善患有危及生命疾病的住院患者的护理情况并降低成本。目前尚无多中心随机试验研究其对患者满意度、临床结局及后续医疗保健成本的影响。
评估跨学科姑息治疗服务（IPCS）对出院后6个月内患者满意度、临床结局及护理成本的影响。
多中心随机对照试验。IPCS为干预组患者提供咨询性、跨学科的姑息治疗。对照组接受常规医院护理（UC）。
2002年6月至2003年12月，来自丹佛、波特兰和旧金山一家医院的517例患有危及生命疾病的患者入组。
改良的希望之城患者问卷、总医疗保健成本、临终关怀利用率及生存率。
IPCS在护理体验量表上的得分更高（IPCS：6.9，UC：6.6，p = 0.04），在医生、护士/其他护理人员沟通量表上的得分也更高（IPCS：8.3，UC：7.5，p = 0.0004）。IPCS组患者再次入院时重症监护病房（ICU）收治次数更少（12次对21次，p = 0.04），且每位患者6个月的净成本节省更低，为4855美元（p = 0.001）。IPCS组患者临终关怀的中位住院时间更长（24天对12天，p = 0.04）。生存率或症状控制方面无差异。
IPCS组患者对护理体验和医护人员沟通的满意度更高，再次入院时ICU收治次数更少，出院后的总医疗保健成本更低。
