Address correspondence to Jody Comart, Palliative Care, Hebrew Rehabilitation Center, 1200 Centre St., Boston, MA 02131. E-mail:
Gerontologist. 2013 Oct;53(5):874-80. doi: 10.1093/geront/gns154. Epub 2012 Dec 7.
To determine whether a palliative care (PC) consult service in a long-term care (LTC) facility would result in a more favorable course of treatment and clinical outcomes for participating residents.
We used a historical control design within a single LTC facility. Outcome data and potential confounding variables were obtained using the Minimum Data Set. (Health Care Financing Administration. (1995). Long term care resident assessment instrument user's manual version 2.0. Rockville, MD: Health Care Financing Administration.) Residents who died during the period of the PC service (2007-2009) were compared with matched residents who died in the year prior (2006, historical controls). The analysis sample included 250 residents (125 PC residents, 125 non-PC historical control residents). Our main analysis focused on a composite outcome based on utilization patterns, depression, and pain and other clinical indicators. We analyzed change on this component score (and the individual outcomes) over a 1-year period.
PC residents experienced a significant reduction in emergency room (ER) visits (p < .001) and depression (p = .031). Change in the composite score indicated a significant difference over time between the 2 groups (p = .013).
Although limited to 1 facility and drawn from a quasi-experimental design, the results demonstrate the potential for improved quality of care with PC consults. The PC team was effective in reducing ER visits and depression and promoted more appropriate care resulting in more favorable clinical outcomes toward the resident's end of life.
确定长期护理（LTC）机构中的姑息治疗（PC）咨询服务是否会导致参与居民的治疗过程和临床结果更加有利。
我们在单个 LTC 机构内使用了历史对照设计。使用最低数据集（医疗保健融资管理局。（1995 年）。长期护理居民评估工具用户手册版本 2.0. 罗克维尔，MD：医疗保健融资管理局。）获得了结果数据和潜在的混杂变量。在 PC 服务期间（2007-2009 年）死亡的居民与同年（2006 年，历史对照）死亡的匹配居民进行了比较。分析样本包括 250 名居民（125 名 PC 居民，125 名非 PC 历史对照居民）。我们的主要分析集中在基于利用模式、抑郁和疼痛以及其他临床指标的综合结果上。我们分析了 1 年内该综合评分（和个别结果）的变化。
PC 居民急诊室（ER）就诊次数显著减少（p <.001），抑郁发生率降低（p =.031）。两组之间在复合评分上的变化随时间显著不同（p =.013）。
尽管仅限于 1 个机构，并且来自准实验设计，但结果表明 PC 咨询可能会提高护理质量。PC 团队在减少急诊室就诊和抑郁方面非常有效，并促进了更适当的护理，从而使居民临终时的临床结果更加有利。
