1 University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania.
J Palliat Med. 2014 Jun;17(6):721-4. doi: 10.1089/jpm.2013.0571. Epub 2014 Apr 18.
All hospices were required by the Centers for Medicare and Medicaid Services (CMS) to collect the "Comfortable Dying" measure in 2012 (National Quality Forum measure #0209). However, it is not known how scores on this measure are affected by patient characteristics. It is important to identify these characteristics so that a hospice's case mix can be taken into account when interpreting its scores.
Our aim was to describe the implementation of the NQF #0209 measure in 10 hospices and to identify patient characteristics associated with scores.
We conducted an electronic health record (EHR)-based retrospective cohort study of patients in 10 hospices in the United States. The main outcome measure was the proportion of patients with pain that made them uncomfortable whose pain was controlled within 48 hours.
A total of 4157 patients were eligible for an initial pain assessment. Of those who reported pain (n=1992), 1152 (58%) reported having their pain controlled on the follow-up assessment. In a multivariable regression model, clustered by hospice, six variables were independently associated with pain control. These included age (adjusted odds ratio [OR] 1.02; 95% confidence interval [CI] 1.02-1.03, p=0.003), a cancer diagnosis (OR 1.37; 95% CI 1.20-1.53, p=0.008), initial care in an inpatient unit (OR 1.28; 95% CI 1.08-1.47, p=0.031), presence of a Foley catheter (OR 1.40; 95% CI 1.15-1.59, p=0.038), use of opioid medication (OR 1.34; 95% CI 1.03-1.74, p=0.027), and higher Palliative Performance Scale (PPS) score (OR 1.02; 95% CI 1.01-1.03, p<0.001). Presence of a Stage 2 pressure ulcer was independently associated with worse pain control (OR 0.63; 95% CI 0.31-0.96, p=0.012).
Several patient characteristics are associated with #0209 pain scores. As hospices are increasingly required to report quality measures, it will be essential to understand how their scores are affected by case mix.
所有的临终关怀机构都被医疗保险和医疗补助服务中心（CMS）要求在 2012 年收集“舒适死亡”指标（国家质量论坛指标#0209）。然而，目前尚不清楚该指标的分数会受到哪些患者特征的影响。确定这些特征很重要，以便在解释临终关怀机构的分数时，可以考虑其病例组合。
我们的目的是描述美国 10 家临终关怀机构实施 NQF #0209 指标的情况，并确定与评分相关的患者特征。
我们对美国 10 家临终关怀机构的电子健康记录（EHR）进行了基于回顾性队列的研究。主要结局指标是在 48 小时内控制疼痛的患者比例，这些患者的疼痛使他们感到不适。
共有 4157 名患者有资格进行初始疼痛评估。在报告疼痛的患者中（n=1992），1152 名（58%）报告在后续评估中疼痛得到控制。在按临终关怀机构聚类的多变量回归模型中，有 6 个变量与疼痛控制独立相关。这些变量包括年龄（调整后的优势比[OR] 1.02；95%置信区间[CI] 1.02-1.03，p=0.003）、癌症诊断（OR 1.37；95% CI 1.20-1.53，p=0.008）、初始在住院病房接受治疗（OR 1.28；95% CI 1.08-1.47，p=0.031）、存在 Foley 导管（OR 1.40；95% CI 1.15-1.59，p=0.038）、使用阿片类药物（OR 1.34；95% CI 1.03-1.74，p=0.027）和较高的临终关怀表现量表（PPS）评分（OR 1.02；95% CI 1.01-1.03，p<0.001）。存在 2 期压疮与疼痛控制较差独立相关（OR 0.63；95% CI 0.31-0.96，p=0.012）。
有几个患者特征与#0209 疼痛评分相关。随着临终关怀机构越来越需要报告质量指标，了解其评分受到病例组合的影响将至关重要。
