Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
J Palliat Med. 2010 Jan;13(1):49-57. doi: 10.1089/jpm.2009.0166.
Acute palliative care units (APCUs) are new programs aimed at integrating palliative and oncology care. Few outcome studies from APCUs are available.
We examined the frequency, survival, and predictors associated with home discharge and death in our APCU.
All patients discharged from the APCU between September 1, 2003 and August 31, 2008 were included. Demographics, cancer diagnosis, discharge outcomes, and overall survival from discharge were retrieved retrospectively.
The 2568 patients admitted to APCU had the following characteristics: median age, 59 years (range, 18-101); male, 51%; median hospital stay, 11 days; median APCU stay, 7 days; and median survival 21 days (95% confidence interval [CI] 19-23 days). Five hundred ninety-two (20%), 89 (3%), and 1259 (43%) patients were discharged to home, health care facilities, and hospice, respectively, with a median survival of 60, 29, and 14 days, respectively (p < 0.001). Nine hundred fifty-eight (33%) patients died during admission (median stay, 11 days). Compared to hospice transfers, home discharge (hazard ratio = 0.35, 95% CI 0.30-0.41, p < 0.001) was associated with longer survival in multivariate analysis, with a 6-month survival of 22%. Multivariate logistic regression revealed that male gender, specific cancer primaries, and admissions from oncology units were associated with death in the APCU, while younger age and direct admissions to the APCU were associated with home discharge.
Our APCU serves patients with advanced cancer with diverse clinical characteristics and survival, and discharged home a significant proportion with survival greater than 6 months. RESULTS from this simultaneous care program suggest a pattern of care different from that of traditional hospice and palliative care services.
急性缓和医疗病房（APCUs）是旨在整合缓和医疗和肿瘤学护理的新项目。目前，关于 APCUs 的结果研究很少。
我们检查了我们的 APCU 中患者出院回家和死亡的频率、生存率和相关预测因素。
纳入 2003 年 9 月 1 日至 2008 年 8 月 31 日期间从 APCU 出院的所有患者。回顾性检索人口统计学、癌症诊断、出院结局和出院后的总生存情况。
2568 名入住 APCU 的患者具有以下特征：中位年龄 59 岁（范围，18-101 岁）；男性，51%；中位住院时间 11 天；中位 APCU 住院时间 7 天；中位生存时间 21 天（95%置信区间 [CI] 19-23 天）。分别有 592（20%）、89（3%）和 1259（43%）名患者出院回家、医疗保健机构和临终关怀，中位生存时间分别为 60、29 和 14 天（p < 0.001）。958（33%）名患者在住院期间死亡（中位住院时间 11 天）。与临终关怀转介相比，多变量分析显示，出院回家（危险比 = 0.35，95%CI 0.30-0.41，p < 0.001）与更长的生存时间相关，6 个月生存率为 22%。多变量逻辑回归显示，男性、特定癌症原发灶和从肿瘤科转入 APCU 与 APCU 死亡相关，而年龄较小和直接转入 APCU 与出院回家相关。
我们的 APCU 为患有晚期癌症的患者提供服务，这些患者具有不同的临床特征和生存情况，出院回家的患者中有很大一部分患者的生存时间超过 6 个月。来自这一同步护理项目的结果表明，其护理模式与传统的临终关怀和姑息治疗服务不同。
