Teno Joan M, Freedman Vicki A, Kasper Judith D, Gozalo Pedro, Mor Vincent
1 Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, Rhode Island.
2 Institute for Social Research, University of Michigan , Ann Arbor, Michigan.
J Palliat Med. 2015 Aug;18(8):662-6. doi: 10.1089/jpm.2015.0039. Epub 2015 Apr 29.
Striking changes occurred in health care in the United States between 2000 and 2013, including growth of hospice and hospital-based palliative care teams, and changes in Medicare payment policies.
The aim of this study was to compare informants' reports and ratings of the quality of end-of-life care for decedents between 2000 and 2011-2013.
The study design comprised retrospective national surveys. Subjects were decedents age 65 years and older residing in the community from two time periods. Similar survey questions were asked at the two time periods. Bivariate and multivariate analyses were conducted, using appropriate survey weights to examine response differences between time periods, after adjusting for the decedent's age, race, pattern of functional decline, and the presence of a cancer diagnosis, as well as the respondent's relationship to the decedent.
A total of 1208 informants were interviewed; 622 in 2000 and 586 in 2011-2013. Respondents from deaths in 2011-2013 were more likely to state that their loved ones experienced an unmet need for pain management (25.2% versus 15.5% in 2000, adjusted odds ratio [AOR] 1.9, 95% confidence interval [CI] 1.1-3.3). More respondents reported that religion and spirituality were addressed in the later time period (72.4% not addressed compared with 58.3%, AOR 1.4, 95% CI 1.1-1.9). High rates of unmet need for palliation of dyspnea and anxiety/depression remained. The overall rating of quality did not improve but decreased (with 56.7% stating care was excellent in 2000 and 47.0% in the later survey, AOR 0.70, 95% CI 0.52-0.95).
Substantial unmet needs in end-of-life care remain. Continued efforts are needed to improve the quality of end-of-life care.
2000年至2013年间，美国医疗保健领域发生了显著变化，包括临终关怀和医院姑息治疗团队的发展，以及医疗保险支付政策的变化。
本研究旨在比较2000年至2011 - 2013年间信息提供者对死者临终关怀质量的报告和评级。
研究设计包括回顾性全国调查。研究对象为两个时间段居住在社区的65岁及以上死者。两个时间段询问了相似的调查问题。进行了双变量和多变量分析，使用适当的调查权重来检验时间段之间的反应差异，同时调整死者的年龄、种族、功能衰退模式、癌症诊断情况，以及受访者与死者的关系。
共采访了1208名信息提供者；2000年622名，2011 - 2013年586名。2011 - 2013年死亡案例的受访者更有可能表示他们所爱的人在疼痛管理方面存在未满足的需求（25.2%对2000年的15.5%，调整后比值比[AOR]为1.9，95%置信区间[CI]为1.1 - 3.3）。更多受访者报告称在后期时间段宗教和精神需求得到了关注（未得到关注的比例为72.4%，而2000年为58.3%，AOR为1.4，95% CI为1.1 - 1.9）。呼吸困难和焦虑/抑郁缓解方面未满足需求的比例仍然很高。总体质量评级没有提高反而下降（2000年称护理优秀的比例为56.7%，后期调查为47.0%，AOR为0.70，95% CI为0.52 - 0.95）。
临终关怀中仍存在大量未满足的需求。需要持续努力提高临终关怀的质量。
