duPreez Amanda E, Smith Maureen A, Liou Jinn-Ing, Frytak Jennifer R, Finch Michael D, Cleary James F, Kind Amy J H
Center for Women's Health Research, University of Wisconsin School of Medicine and Public Health and Meriter Hospital, Madison, Wisconsin 53726, USA.
J Palliat Med. 2008 Nov;11(9):1249-57. doi: 10.1089/jpm.2008.0124.
Hospice is considered to be underutilized, particularly among patients with noncancer diagnoses such as stroke. The highest mortality among stroke patients occurs within the first 30 days; however, we know little about the hospice enrollment decision for this population during this critical time frame.
To determine hospice enrollment rates and to describe sociodemographic and clinical predictors of hospice utilization among patients who die within 30 days of their stroke.
Retrospective analysis of administrative data.
Medicare beneficiaries 65 years and older discharged with ischemic stroke from 422 hospitals and 11 metropolitan regions during the year 2000 who died within 30 days of their stroke.
Hospice utilization within 30 days.
The overall hospice enrollment rate in our study was 23%. Using multivariable logistic regression, factors predicting increased hospice enrollment included older age, female gender, health management organization (HMO) membership, length of stay more than 3 days, and dementia. Factors predicting decreased enrollment included African American race, mechanical ventilation, gastrostomy tube placement, uncomplicated diabetes mellitus, and valvular disease. When in-hospital deaths were excluded, overall enrollment increased to 44%, and mechanical ventilation and dementia ceased to predict enrollment.
Hospice enrollment rates among patients who die within the first 30 days of their stroke, particularly among those who survive to discharge, are much higher than prior estimates suggest. Although overall enrollment rates were higher than anticipated, there remain important sociodemographic and clinical characteristics unique to this population that predict low hospice utilization that should serve as targets for further research and intervention.
临终关怀被认为未得到充分利用，尤其是在患有中风等非癌症诊断的患者中。中风患者的最高死亡率发生在发病后的前30天内；然而，我们对这一关键时间段内该人群的临终关怀登记决策知之甚少。
确定临终关怀登记率，并描述在中风后30天内死亡的患者中临终关怀利用的社会人口学和临床预测因素。
对行政数据进行回顾性分析。
2000年期间，来自422家医院和11个大都市地区的65岁及以上因缺血性中风出院且在中风后30天内死亡的医疗保险受益人。
30天内的临终关怀利用情况。
我们研究中的总体临终关怀登记率为23%。使用多变量逻辑回归分析，预测临终关怀登记增加的因素包括年龄较大、女性、健康管理组织（HMO）成员身份、住院时间超过3天以及痴呆。预测登记减少的因素包括非裔美国人种族、机械通气、胃造瘘管放置、无并发症的糖尿病和瓣膜疾病。排除院内死亡病例后，总体登记率增至44%，机械通气和痴呆不再是登记的预测因素。
在中风后30天内死亡的患者中，尤其是那些存活至出院的患者，临终关怀登记率远高于先前估计。尽管总体登记率高于预期，但该人群仍存在重要的社会人口学和临床特征，这些特征预示着临终关怀利用率较低，应作为进一步研究和干预的目标。
