Wang Lin, Piet Leslie, Kenworthy Catherine M, Dy Sydney M
The Johns Hopkins Medical Institutions, Johns Hopkins Health Care, Department of Care Management Administration, Baltimore, MD, USA
The Johns Hopkins Medical Institutions, Johns Hopkins Health Care, Department of Care Management Administration, Baltimore, MD, USA.
Am J Hosp Palliat Care. 2015 Mar;32(2):216-20. doi: 10.1177/1049909113520067. Epub 2014 Jan 20.
Association between palliative case management (PCM) and the utilization of major health services during the last 30 days of life in Medicaid patients with cancer was assessed using retrospective cohort analysis. There were 132 PCM enrollees in the intervention group and 54 non-PCM enrollees in the comparison group. The intervention group had lower inpatient admission rate than that of the comparison group (56.8% vs 74.1%), lower ICU admission rate (12.9% vs 24.1%), longer mean hospice days (45.8 vs 31.1 days), and lower percentage of persons with death in hospital (24.2% vs 35.9%). No statistically significant differences were found in mean intensive care unit days (8.7 vs 9.7 days), treat-and-release emergency department visit rate (22.0% vs 16.7%), or hospice election rate (65.9% vs 70.4%). Palliative case management may reduce hospitalization and increase hospice use in patients nearing death.
采用回顾性队列分析评估了姑息治疗病例管理（PCM）与医疗补助计划癌症患者生命最后30天内主要医疗服务利用情况之间的关联。干预组有132名参加PCM的患者，对照组有54名未参加PCM的患者。干预组的住院率低于对照组（56.8%对74.1%），重症监护病房（ICU）收治率较低（12.9%对24.1%），平均临终关怀天数更长（45.8天对31.1天），且在医院死亡的患者比例较低（24.2%对35.9%）。在平均重症监护病房天数（8.7天对9.7天）、治疗后出院的急诊科就诊率（22.0%对16.7%）或临终关怀选择率（65.9%对70.4%）方面未发现统计学上的显著差异。姑息治疗病例管理可能会减少临终患者的住院率并增加临终关怀的使用。
