Department of Public and Occupational Care, The EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
Palliat Med. 2010 Mar;24(2):166-74. doi: 10.1177/0269216309351381. Epub 2009 Dec 10.
Multiple transitions between care settings in the last phase of life could jeopardize continuity of care and overall end-of-life patient care. Using a mortality follow-back study, we examined the nature and prevalence of transitions between Dutch care settings in the last 3 months of life, and identified potential characteristics associated with them. During the 2-year study period, 690 registered patients died 'totally expectedly and non-suddenly'. These made 709 transitions in the last 3 months, which involved a hospital two times out of three, and covered 43 distinct care trajectories. The most frequent trajectory was home-to-hospital (48%). Forty-six percent experienced one or more transitions in their last month of life. Male gender, multi-morbidities, and absence of GP awareness of a patient's wish for place of death were associated with having a transition in the last 30 days of life; age of < or = 85 years, having an infection and the absence of a palliative-centred treatment goal were associated with terminal hospitalization for > or = 7 days. Although the majority of the 'totally expected and non-sudden' deaths occurred at home, transitions to hospitals were relatively frequent. To minimize abrupt or frequent transitions just before death, timely recognition of the palliative phase of dying is important.
在生命的最后阶段，多次在医疗保健环境之间转换可能会危及护理的连续性和整体临终关怀。本研究采用死亡后回溯研究，调查了荷兰生命最后 3 个月中医疗保健环境转换的性质和频率，并确定了与这些转换相关的潜在特征。在为期 2 年的研究期间，690 名已登记的患者“完全可预见且非突然”死亡。这些患者在生命的最后 3 个月中进行了 709 次转换，其中三分之二涉及医院，涵盖了 43 种不同的护理轨迹。最常见的轨迹是从家到医院（48%）。46%的患者在生命的最后一个月经历了一次或多次转换。男性、多病共存和全科医生对患者对死亡地点的意愿缺乏了解与生命最后 30 天的转换有关；年龄<或=85 岁、感染以及缺乏以姑息治疗为中心的治疗目标与>或=7 天的终末期住院有关。尽管大多数“完全可预见且非突然”的死亡发生在家里，但到医院的转换相对频繁。为了尽量减少死亡前的突然或频繁转换，及时识别临终的姑息阶段很重要。
