Palliative Care Program, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California, USA.
J Pain Symptom Manage. 2012 Jan;43(1):39-46. doi: 10.1016/j.jpainsymman.2011.03.021. Epub 2011 Jul 30.
In 2000, 17% of California hospitals offered palliative care (PC) services. Since then, hospital-based PC programs have become increasingly common, and preferred practices for these services have been proposed by expert consensus.
We sought to examine the prevalence of PC programs in California, their structure, and the hospital characteristics associated with having a program.
A total of 351 acute care hospitals in California completed a survey that determined the presence of and described the structure of PC services. Logistic regression identified hospital characteristics associated with having a PC program.
A total of 324 hospitals (92%) responded, of which 44% (n=141) reported having a PC program. Hospitals most likely to have PC programs were large nonprofit facilities that belonged to a health system, had teaching programs, and had participated in a training program designed to promote development of PC services. Investor-owned sites (odds ratio [OR]=0.08; 95% confidence interval [CI]=0.03, 0.2) and city/county facilities (OR=0.06; 95% CI=0.01, 0.3) were less likely to have a PC program. The most common type of PC service was an inpatient consultation service (88%), staffed by a physician (87%), social worker (81%), chaplain (76%), and registered nurse (74%). Most programs (71%, n=86) received funding from the hospital and were expected to meet goals set by the hospital or health system.
Although the number of hospital-based PC services in California has doubled since 2000, more than half of the acute care hospitals still do not provide PC services. Developing initiatives that target small, public, and investor-owned hospitals may lead to wider availability of PC services.
2000 年，17%的加利福尼亚医院提供姑息治疗（PC）服务。此后，基于医院的 PC 计划变得越来越普遍，并且专家共识提出了这些服务的首选实践。
我们旨在检查加利福尼亚州 PC 计划的流行率、其结构以及与拥有计划相关的医院特征。
加利福尼亚州共有 351 家急症护理医院完成了一项调查，该调查确定了 PC 服务的存在并描述了其结构。逻辑回归确定了与拥有 PC 计划相关的医院特征。
共有 324 家医院（92%）做出了回应，其中 44%（n=141）报告说拥有 PC 计划。最有可能拥有 PC 计划的医院是非营利性大型医疗机构，属于医疗系统，拥有教学计划，并参加了旨在促进 PC 服务发展的培训计划。投资者所有的机构（优势比[OR]=0.08；95%置信区间[CI]=0.03，0.2）和市/县机构（OR=0.06；95%CI=0.01，0.3）不太可能拥有 PC 计划。最常见的 PC 服务类型是住院会诊服务（88%），由医生（87%）、社工（81%）、牧师（76%）和注册护士（74%）提供。大多数计划（71%，n=86）由医院提供资金，并预计达到医院或医疗系统设定的目标。
尽管自 2000 年以来，加利福尼亚州的基于医院的 PC 服务数量增加了一倍，但仍有一半以上的急症护理医院未提供 PC 服务。针对小型、公立和投资者所有的医院制定计划可能会导致更广泛地提供 PC 服务。
