Porzio Giampiero, Aielli Federica, Verna Lucilla, Martella Francesco, Aloisi Paolo, Ficorella Corrado
L'Aquila per Vita Home Care Unit, L'Aquila, Italy.
Tumori. 2013 Mar-Apr;99(2):225-8. doi: 10.1177/030089161309900217.
To evaluate the efficacy of a home care program, closely integrated with a medical oncology department.
The charts, prospectively recorded, of all the patients treated at home by the "L'Aquila per la Vita" Home Care Unit from August 2006 to December 2011, were reviewed. The number of patients, home accesses, length of the home care, hospital admission, emergency calls, and the place of death were recorded. Data were analyzed considering the origin of the patients (medical oncology department or other).
A total of 461 patients was followed at home for a total of 10,503 home accesses (median accesses/patient, 20; range, 1-159). The median length of home care was 76 days (range, 2-643 days). The median was 101 days for patients coming from the medical oncology department and 53 days for patients coming from other origins (P <0.0005). There were 428 emergency calls (4.1% of all the home accesses). Emergency calls accounted for 253 of 7,364 home accesses (3.4%) among patients coming from the medical oncology department and for 175 of 3,139 home accesses (5.6%) among patients coming from other origins (P = 0.00005). Eighty of 461 patients (17.3%) required one in-hospital admission and 19/461 patients (4.1%) more than one. Fifty-nine of 259 (17.8%) patients coming from the medical oncology department and 40 of 186 (26.9%) coming from other origins required in-hospital admissions (P = 0.04). A total of 311 patients died (163 coming from the medical oncology department and 148 from other origins). Twenty-eight of 163 (17.1%) coming from the medical oncology department and 52 of 148 (35.1%) coming from other origins died in the hospital (P = 0.0002).
A multidisciplinary and expert team, closely integrated with the hospital, can guarantee a long length of home care, avoiding hospitalization and closing the gap between the patients' preferences and the services offered regarding the place of death.
评估一项与肿瘤内科紧密结合的居家护理项目的疗效。
回顾了2006年8月至2011年12月期间由“阿奎拉生命关怀”居家护理单元在家中治疗的所有患者的前瞻性记录图表。记录了患者数量、居家护理次数、居家护理时长、住院情况、急救电话以及死亡地点。根据患者来源（肿瘤内科或其他）对数据进行分析。
共对461例患者进行了居家随访，总计10503次居家护理（每位患者的护理次数中位数为20次；范围为1 - 159次）。居家护理的时长中位数为76天（范围为2 - 643天）。来自肿瘤内科的患者时长中位数为101天，来自其他来源的患者为53天（P <0.0005）。共有428次急救电话（占所有居家护理次数的4.1%）。急救电话在来自肿瘤内科的患者的7364次居家护理中占253次（3.4%），在来自其他来源的患者的3139次居家护理中占175次（5.6%）（P = 0.00005）。461例患者中有80例（17.3%）需要住院一次，19/461例患者（4.1%）需要住院不止一次。来自肿瘤内科的259例患者中有59例（17.8%）需要住院，来自其他来源的186例患者中有40例（26.9%）需要住院（P = 0.04）。共有311例患者死亡（163例来自肿瘤内科，148例来自其他来源）。来自肿瘤内科的163例患者中有28例（17.1%）在医院死亡，来自其他来源的148例患者中有52例（35.1%）在医院死亡（P = 0.0002）。
一个与医院紧密结合的多学科专家团队能够保证较长的居家护理时长，避免住院，并弥合患者在死亡地点偏好与所提供服务之间的差距。
