De Roo Maaike L, Francke Anneke L, Van den Block Lieve, Donker Gé A, Alonso Jose E Lozano, Miccinesi Guido, Moreels Sarah, Onwuteaka-Philipsen Bregje D, Salvetti Andrea, Deliens Luc
Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands ; NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands.
BMC Palliat Care. 2014 Nov 27;13:54. doi: 10.1186/1472-684X-13-54. eCollection 2014.
Repeated and long hospitalizations of cancer patients at the end of life have been suggested as indicators of low quality of palliative care. Comparing the care delivered between different countries with the help of these quality indicators may identify opportunities to improve practice. Our objective is twofold: firstly, to describe the scores for the existing quality indicators "the percentage of time spent in hospital" and "the proportion of adult patients with more than one hospitalization in the last 30 days of life" in populations of cancer patients in four European countries and to see whether these countries met previously defined performance standards; secondly, to assess whether these scores are related to receiving palliative care from their GP.
A mortality follow-back study was conducted, based on data recorded by representative GP networks for samples of cancer patients living at home who died non-suddenly in Belgium (n = 500), the Netherlands (n = 310), Italy (n = 764), and Spain (n = 224).
The quality indicator score for "the percentage of time spent in hospital" in the last month of life was 14.1% in the Netherlands, 17.7% in Spain, 22.2% in Italy, and 24.6% in Belgium, which means that none of the countries met the performance standard of <10%. For the "proportion of patients with more than one hospitalization in the last 30 days of life", two countries met the performance standard of <4%: the Netherlands (0.6%) and Italy (3.1%). Spain had a score of 4.0% and Belgium scored 5.4%. When patients received palliative care from their GP, significantly less time was spent in hospital in the last month and fewer hospitalizations took place.
European countries differ regarding the frequency and duration of hospitalizations of cancer patients in the last month of life. This reflects country-specific differences in the organization of palliative care and highlights the important role of the GP in palliative care provision.
癌症患者在生命末期反复且长期住院被视为姑息治疗质量低下的指标。借助这些质量指标比较不同国家提供的护理情况，可能会发现改进实践的机会。我们的目标有两个：其一，描述四个欧洲国家癌症患者群体中现有质量指标“住院时间百分比”和“在生命的最后30天内有多次住院的成年患者比例”的得分情况，并查看这些国家是否达到先前定义的绩效标准；其二，评估这些得分是否与从其全科医生处接受姑息治疗有关。
进行了一项死亡回顾研究，基于比利时（n = 500）、荷兰（n = 310）、意大利（n = 764）和西班牙（n = 224）居家非突然死亡的癌症患者样本，由具有代表性的全科医生网络记录的数据。
在生命的最后一个月，“住院时间百分比”这一质量指标的得分在荷兰为14.1%，在西班牙为17.7%，在意大利为22.2%，在比利时为24.6%，这意味着没有一个国家达到<10%的绩效标准。对于“在生命的最后30天内有多次住院的患者比例”，有两个国家达到了<4%的绩效标准：荷兰（0.6%）和意大利（3.1%）。西班牙的得分为4.0%，比利时的得分为5.4%。当患者从其全科医生处接受姑息治疗时，在最后一个月的住院时间明显减少，住院次数也减少。
欧洲国家在癌症患者生命最后一个月的住院频率和时长方面存在差异。这反映了姑息治疗组织方面的国家特定差异，并凸显了全科医生在提供姑息治疗中的重要作用。
