Department of Social and Behavioral Sciences, Sutter Health Institute for Research and Education, University of California San Francisco, San Francisco, California 94104, USA.
J Palliat Med. 2010 May;13(5):541-8. doi: 10.1089/jpm.2009.0300.
Inpatient palliative care teams' (PCT) contribution to improved quality of life and patient satisfaction as well as decreased utilization and costs has been well established. Yet few studies have examined the specific effect of an inpatient PCT on discharge disposition, despite evidence of an association between hospice enrollment, decreased rehospitalization, and improved resource utilization.
Patients admitted to a large nonprofit multisite hospital between June 2004 and December 2007 and seen by the PCT were matched to usual care (UC) patients on age, mortality risk, prior year hospitalized days, and disease severity. Discharge disposition and demographic factors were abstracted from hospital administrative claims; mortality data was collected from the social security death index. Analyses were performed using Wilcoxon's test, chi(2) analysis, and multinomial logit regression.
Three hundred sixty-one matched pairs were available for analysis. Compared to UC, patients who received a PCT consultation were 3.24 times more likely to be discharged to hospice (p < 0.0001), 1.52 times more likely to be discharged to a nursing facility, and 1.59 times more likely to be discharged home with services (p < 0.001), controlling for patient demographics and disease severity. PCT patients were also referred to hospice earlier in their disease trajectory, rather than in the last few weeks of life.
Patients receiving an inpatient PCT consultation are more likely to receive follow-up services upon discharge from the hospital. These services likely contribute to better quality of care and financial benefits, and warrants further study, especially considering the current focus on health care efficiency and quality.
住院姑息治疗团队（PCT）在提高生活质量和患者满意度、减少利用和成本方面的贡献已得到充分证实。然而，尽管有证据表明姑息治疗入院与减少再入院和改善资源利用之间存在关联，但很少有研究探讨住院 PCT 对出院安置的具体影响。
2004 年 6 月至 2007 年 12 月期间，在一家大型非营利性多地点医院住院的患者和 PCT 一起接受治疗，他们与常规护理（UC）患者在年龄、死亡率风险、前一年住院天数和疾病严重程度上相匹配。从医院管理索赔中提取出院安置和人口统计因素；从社会保障死亡指数中收集死亡率数据。使用 Wilcoxon 检验、卡方分析和多项逻辑回归进行分析。
共有 361 对匹配的患者可供分析。与 UC 相比，接受 PCT 咨询的患者被安置到临终关怀机构的可能性高出 3.24 倍（p<0.0001），被安置到护理机构的可能性高出 1.52 倍，被安置到家庭并接受服务的可能性高出 1.59 倍（p<0.001），同时控制了患者的人口统计学和疾病严重程度。PCT 患者也更早地被转诊到临终关怀，而不是在生命的最后几周。
接受住院 PCT 咨询的患者在出院后更有可能接受后续服务。这些服务可能有助于提高护理质量和带来经济利益，值得进一步研究，特别是考虑到当前对医疗保健效率和质量的关注。
