Department of Palliative Care, Barwon Health, Victoria, Australia.
J Palliat Med. 2012 Mar;15(3):327-33. doi: 10.1089/jpm.2011.0319. Epub 2012 Feb 22.
Increasing demand for palliative care unit (PCU) beds has led to shorter inpatient stays and a requirement to transfer some patients from a PCU to a residential aged care facility (RACF). Concerns have been raised regarding this move with suggestion that patients often die shortly after transfer. Published data investigating this patient group are limited. The aim of the current study was to audit discharges from a PCU to RACFs specifically looking at predictive factors for survival following discharge.
A retrospective audit was undertaken of all discharges from the Barwon Health PCU to RACFs between July 2007 and July 2010. Data on patient demographics, clinical and functional status, admission and discharge details, and survival times were examined. Factors influencing survival were evaluated by Cox proportional-hazards regression analysis.
Sixty-two discharges from a PCU to an RACF were included in the analysis. The mean age at discharge was 76 and the majority of patients had malignant disease. Mean and median survival times post-transfer were 106 and 42.5 days, respectively, and 16% of subjects survived more than 100 days. From univariate analyses age, PCU length of stay, admission Resource Utilization Groups-Activities of Daily Living (RUG-ADL) score, dependent mobility, having lung cancer or cancer of unknown primary, and living alone or in an RACF pre PCU admission affected survival. Multivariate analyses showed age, PCU length of stay, RUG-ADL score, and living situation prior to PCU admission together were associated with postdischarge survival times.
This study is one of the largest investigating this cohort and suggests a number of factors that may predict survival for patients after discharge from a PCU to an RACF.
对缓和医疗病房（PCU）床位的需求不断增加，导致住院时间缩短，并需要将一些患者从 PCU 转移到养老院（RACF）。有人对这一举措表示担忧，认为患者在转移后往往很快就去世了。目前，关于这一患者群体的研究数据有限。本研究旨在对从 PCU 转移到 RACF 的患者进行出院审核，特别关注出院后存活的预测因素。
对 2007 年 7 月至 2010 年 7 月期间从 Barwon Health PCU 转移到 RACF 的所有患者进行回顾性审核。审查了患者的人口统计学、临床和功能状况、入院和出院详细信息以及存活时间等数据。采用 Cox 比例风险回归分析评估影响生存的因素。
共纳入了 62 例从 PCU 转移到 RACF 的患者。出院时的平均年龄为 76 岁，大多数患者患有恶性肿瘤。转移后平均和中位存活时间分别为 106 天和 42.5 天，16%的患者存活时间超过 100 天。单因素分析显示，年龄、PCU 住院时间、入院资源利用组-日常生活活动（RUG-ADL）评分、依赖移动能力、患有肺癌或不明原发癌以及 PCU 入院前独居或居住在养老院等因素均影响生存。多因素分析显示，年龄、PCU 住院时间、RUG-ADL 评分以及 PCU 入院前的生活状况与出院后的存活时间有关。
本研究是调查该队列的最大规模研究之一，提示了一些可能预测患者从 PCU 转移到 RACF 后存活的因素。
