Palliative and Supportive Services, Flinders University, Daw Park, South Australia, Australia.
J Pain Symptom Manage. 2011 Oct;42(4):505-10. doi: 10.1016/j.jpainsymman.2011.06.007.
Hospice and palliative care services need to be able to compete with finite health care resources. To compete for such funding, the sector needs to continuously improve the evidence base that demonstrates improved outcomes, or else funding will continue to be at the level of a "social good" rather than as services that deliver improved health outcomes. Three questions need to be answered for policy makers and health funders: 1) Why invest health care spending in hospice and palliative care?, 2) Why invest research monies in hospice and palliative care clinical research and health service development?, and 3) How can emerging evidence be more effectively implemented to improve patient outcomes? No single measure captures the net benefit of hospice and palliative care services. By patient-defined parameters, hospice and palliative care services have demonstrated benefits, including physical symptom control. To meet patients' concerns, greater emphasis needs to be placed on maintaining physical independence for a longer period of time. Targeted investment of research funding can deliver further improvements in patient outcomes and models of service delivery. Rigorous studies are feasible and necessary if each patient is going to receive the best possible support. Benchmarking and service development strategies can deliver improved patient outcomes. With routine point-of-care data collection and feedback loops to individual services, patient-valued outcomes and resourcing can be improved in hospice and palliative care. Public-good investments in hospice and palliative care research are vital to building the evidence base for improving the quality of care offered.
临终关怀和姑息治疗服务需要能够与有限的医疗资源竞争。为了争夺此类资金，该领域需要不断完善证据基础，证明改善了治疗结果，否则资金将继续处于“社会公益”水平，而不是作为提供改善健康结果的服务。政策制定者和医疗资金提供者需要回答三个问题：1）为什么要将医疗保健支出投资于临终关怀和姑息治疗？2）为什么要将研究资金投资于临终关怀和姑息治疗临床研究和医疗服务发展？3）如何更有效地实施新出现的证据以改善患者的治疗结果？没有单一的指标可以捕捉到临终关怀和姑息治疗服务的净收益。根据患者定义的参数，临终关怀和姑息治疗服务已经证明具有益处，包括控制身体症状。为了满足患者的担忧，需要更加重视更长时间地保持身体独立性。有针对性地投入研究资金可以进一步改善患者的治疗结果和服务交付模式。如果每个患者都要得到尽可能好的支持，那么进行严格的研究是可行且必要的。基准测试和服务开发策略可以改善患者的治疗结果。通过常规的即时护理数据收集和反馈循环到各个服务，可以改善临终关怀和姑息治疗中的患者价值结果和资源配置。对临终关怀和姑息治疗研究进行公共利益投资对于建立改善所提供护理质量的证据基础至关重要。
