Currow David C, Eagar Kathy, Aoun Samar, Fildes Dave, Yates Patsy, Kristjanson Linda J
Department of Palliative and Supportive Services, Flinders University, Adelaide, Australia.
J Clin Oncol. 2008 Aug 10;26(23):3853-9. doi: 10.1200/JCO.2008.16.5761.
Hospice/palliative care is a critical component of cancer care. In Australia, more than 85% of people referred to specialized hospice/palliative care services (SHPCS) have a primary diagnosis of cancer, and 60% of people who die from cancer will be referred to SHPCS. The Palliative Care Outcomes Collaboration (PCOC) is an Australian initiative that allows SHPCS to collect nationally agreed-upon measures to better understand quality, safety, and outcomes of care. This article describes data (October 2006 through September 2007) from the first 22 SHPCS, with more than 100 inpatient admissions annually. Data include phase of illness, place of discharge, and, at each transition in place of care, the person's functional status, dependency, and symptom scores. Data are available for 5,395 people for 6,379 admissions. After categorizing by phase of illness and dependency, there remain at the end of each admission 12-fold differences (mean, 26%; range, 4% to 52%) in the percentage of patients who became stable after an unstable phase; seven-fold differences (mean, 22%; range, 6% to 41%) in the percentage of patients with improved symptom scores, five-fold differences (mean, 25%; range, 12% to 64%) in discharge back to the community, four-fold differences (mean, 10%; range, 4% to 16%) in improved function, and three-fold differences in the length of stay (mean, 14 days; range, 6 to 19 days). PCOC shows it is feasible to collect quality national palliative care outcome data voluntarily. Variations in outcomes justify continued enrollment of services. Benchmarking should include all patients whose cancer will cause death and explore observed variations.
临终关怀/姑息治疗是癌症护理的重要组成部分。在澳大利亚，超过85%被转介至专业临终关怀/姑息治疗服务机构（SHPCS）的患者的主要诊断为癌症，且60%死于癌症的患者会被转介至SHPCS。姑息治疗结果协作组织（PCOC）是澳大利亚发起的一项倡议，它使SHPCS能够收集全国公认的指标，以更好地了解护理质量、安全性和结果。本文描述了来自最初22家SHPCS的数据（2006年10月至2007年9月），这些机构每年有超过100例住院患者。数据包括疾病阶段、出院地点，以及在每次护理地点转换时患者的功能状态、依赖程度和症状评分。有5395人6379次入院的数据可供分析。按疾病阶段和依赖程度分类后，每次入院结束时，不稳定阶段后病情稳定的患者百分比存在12倍的差异（平均为26%；范围为4%至52%）；症状评分改善的患者百分比存在7倍的差异（平均为22%；范围为6%至41%）；出院返回社区的患者百分比存在5倍的差异（平均为25%；范围为12%至64%）；功能改善的患者百分比存在4倍的差异（平均为10%；范围为4%至16%）；住院时间存在3倍的差异（平均为14天；范围为6至19天）。PCOC表明，自愿收集全国性姑息治疗质量结果数据是可行的。结果的差异证明继续纳入服务机构是合理的。基准比较应包括所有癌症将导致死亡的患者，并探索观察到的差异。
