National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi, South Korea.
Support Care Cancer. 2012 Mar;20(3):539-47. doi: 10.1007/s00520-011-1115-y. Epub 2011 Feb 24.
Hospice programs in Korea have been largely based on volunteer activity, religious services, or social services. Recent government policy of designating medically based inpatient palliative care services and per diem payment system made it necessary to monitor the quality of these services. We examined the variation in the process and outcomes of palliative care services, using 2009 data obtained from the Korean Terminal Cancer Patient Information System.
Data were collected from 3,867 patients with terminal cancer who were registered in 34 inpatient palliative care centers designated by the Ministry of Health and Welfare. We used the mean length of stay and the subsequent place of care as process indicators, and change in average pain score as an outcome indicator. The data were analyzed using descriptive statistics, and analysis of covariance for the case-mix adjustment.
There were considerable variations among services with regards to the mean length of stay (i.e., 10.5 to 32.6 days for each admission) and subsequent place of care (i.e., 39.8% to 92.6% ended in death at the first admission), even after stratification by service level. The mean change in average pain score varied from -1.48 to 2.16, and remained significant after case-mix adjustment.
We found considerable variations among palliative care services with regard to the mean length of stay, subsequent place of care, and change in average pain score. Continued assessment of the variations in process and outcomes will assist in developing the national benchmarking system and the evaluation of the government policy.
韩国的临终关怀项目主要基于志愿者活动、宗教服务或社会服务。最近政府制定了以医疗为基础的住院姑息治疗服务和日定额支付制度的政策，这使得有必要对这些服务的质量进行监测。我们使用 2009 年从韩国终末期癌症患者信息系统获得的数据，检查了姑息治疗服务的过程和结果的变化。
从卫生福利部指定的 34 个姑息治疗中心登记的 3867 名终末期癌症患者中收集数据。我们使用平均住院时间和随后的护理地点作为过程指标，平均疼痛评分的变化作为结果指标。使用描述性统计和协方差分析对数据进行分析，以进行病例组合调整。
尽管按服务水平进行分层，但各服务之间的平均住院时间（每次入院 10.5 至 32.6 天）和随后的护理地点（首次入院时 39.8%至 92.6%死亡）存在相当大的差异。平均疼痛评分的变化从-1.48 到 2.16 不等，在病例组合调整后仍然显著。
我们发现，在平均住院时间、随后的护理地点和平均疼痛评分的变化方面，姑息治疗服务之间存在相当大的差异。对过程和结果变化的持续评估将有助于制定国家基准系统和评估政府政策。
