Chen Christina Y, Thorsteinsdottir Bjorg, Cha Stephen S, Hanson Gregory J, Peterson Stephanie M, Rahman Parvez A, Naessens James M, Takahashi Paul Y
1 Geriatric Medicine Fellowship, Mayo Clinic , Rochester, Minnesota.
J Palliat Med. 2015 Jan;18(1):38-44. doi: 10.1089/jpm.2014.0150.
Approximately 20% of seniors live with five or more chronic medical illnesses. Terminal stages of their lives are often characterized by repeated burdensome hospitalizations and advance care directives are insufficiently addressed. This study reports on the preliminary results of a Palliative Care Homebound Program (PCHP) at the Mayo Clinic in Rochester, Minnesota to service these vulnerable populations.
The study objective was to evaluate inpatient hospital utilization and the adequacy of advance care planning in patients who receive home-based palliative care.
This is a retrospective pilot cohort study of patients enrolled in the PCHP between September 2012 and March 2013. Two control patients were matched to each intervention patient by propensity scoring methods that factor in risk and prognosis. Primary outcomes were six-month hospital utilization including ER visits. Secondary outcomes evaluated advance care directive completion and overall mortality.
Patients enrolled in the PCHP group (n = 54) were matched to 108 controls with an average age of 87 years. Ninety-two percent of controls and 33% of PCHP patients were admitted to the hospital at least once. The average number of hospital admissions was 1.36 per patient for controls versus 0.35 in the PCHP (p < 0.001). Total hospital days were reduced by 5.13 days. There was no difference between rates of ER visits. Advanced care directive were completed more often in the intervention group (98%) as compared to controls (31%), with p < 0.001. Goals of care discussions were held at least once for all patients in the PCHP group, compared to 41% in the controls.
约20%的老年人患有五种或更多慢性疾病。他们生命的终末期往往以反复的沉重住院负担为特征，而预先医疗指示未得到充分落实。本研究报告了明尼苏达州罗切斯特市梅奥诊所的姑息治疗居家项目（PCHP）服务这些弱势群体的初步结果。
本研究的目的是评估接受居家姑息治疗患者的住院利用率以及预先医疗计划的充分性。
这是一项对2012年9月至2013年3月期间纳入PCHP的患者进行的回顾性试点队列研究。通过考虑风险和预后的倾向评分方法，为每名干预患者匹配两名对照患者。主要结局是包括急诊就诊在内的六个月住院利用率。次要结局评估预先医疗指示的完成情况和总体死亡率。
PCHP组（n = 54）的患者与108名对照患者匹配，平均年龄为87岁。92%的对照患者和33%的PCHP患者至少入院一次。对照患者的平均住院次数为每人1.36次，而PCHP组为0.35次（p < 0.001）。总住院天数减少了5.13天。急诊就诊率没有差异。与对照组（31%）相比，干预组（98%）更常完成预先医疗指示，p < 0.001。PCHP组的所有患者都至少进行了一次护理目标讨论，而对照组为41%。
