Department of Oncology, McMaster University, Hamilton, Ontario L8V 5C2, Canada
School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
BMJ. 2014 Jun 6;348:g3496. doi: 10.1136/bmj.g3496.
To determine the pooled effect of exposure to one of 11 specialist palliative care teams providing services in patients' homes.
Pooled analysis of a retrospective cohort study.
Ontario, Canada.
3109 patients who received care from specialist palliative care teams in 2009-11 (exposed) matched by propensity score to 3109 patients who received usual care (unexposed).
The palliative care teams studied served different geographies and varied in team composition and size but had the same core team members and role: a core group of palliative care physicians, nurses, and family physicians who provide integrated palliative care to patients in their homes. The teams' role was to manage symptoms, provide education and care, coordinate services, and be available without interruption regardless of time or day.
Patients (a) being in hospital in the last two weeks of life; (b) having an emergency department visit in the last two weeks of life; or (c) dying in hospital.
In both exposed and unexposed groups, about 80% had cancer and 78% received end of life homecare services for the same average duration. Across all palliative care teams, 970 (31.2%) of the exposed group were in hospital and 896 (28.9%) had an emergency department visit in the last two weeks of life respectively, compared with 1219 (39.3%) and 1070 (34.5%) of the unexposed group (P<0.001). The pooled relative risks of being in hospital and having an emergency department visit in late life comparing exposed versus unexposed were 0.68 (95% confidence interval 0.61 to 0.76) and 0.77 (0.69 to 0.86) respectively. Fewer exposed than unexposed patients died in hospital (503 (16.2%) v 887 (28.6%), P<0.001), and the pooled relative risk of dying in hospital was 0.46 (0.40 to 0.52).
Community based specialist palliative care teams, despite variation in team composition and geographies, were effective at reducing acute care use and hospital deaths at the end of life.
确定在患者家中提供服务的 11 个专业姑息治疗团队之一的暴露对汇总效果。
回顾性队列研究的汇总分析。
加拿大安大略省。
2009 年至 2011 年期间接受专业姑息治疗团队治疗的 3109 名患者（暴露组），通过倾向评分与接受常规护理的 3109 名患者（未暴露组）相匹配。
研究中的姑息治疗团队服务于不同的地理位置，团队组成和规模各不相同，但有相同的核心团队成员和角色：一组核心的姑息治疗医生、护士和家庭医生，他们为家中的患者提供综合姑息治疗。团队的角色是管理症状、提供教育和护理、协调服务，并随时提供服务，无论时间或日期如何。
患者（a）在生命的最后两周内住院；（b）在生命的最后两周内急诊就诊；或（c）在医院死亡。
在暴露组和未暴露组中，约 80%患有癌症，并且 78%接受了相同平均持续时间的临终家庭护理服务。在所有姑息治疗团队中，暴露组中有 970 人（31.2%）在生命的最后两周内住院，896 人（28.9%）在生命的最后两周内急诊就诊，而未暴露组中分别有 1219 人（39.3%）和 1070 人（34.5%）（P<0.001）。与未暴露组相比，暴露组在生命晚期住院和急诊就诊的相对风险分别为 0.68（95%置信区间 0.61 至 0.76）和 0.77（0.69 至 0.86）。暴露组比未暴露组住院死亡的患者更少（503 例（16.2%）比 887 例（28.6%），P<0.001），并且在医院死亡的相对风险为 0.46（0.40 至 0.52）。
尽管团队组成和地理位置存在差异，但基于社区的专业姑息治疗团队在减少临终时的急性护理使用和医院死亡方面是有效的。
