Teno Joan M, Bowman Jason, Plotzke Michael, Gozalo Pedro L, Christian Thomas, Miller Susan C, Williams Cindy, Mor Vincent
Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
J Pain Symptom Manage. 2015 Oct;50(4):548-52. doi: 10.1016/j.jpainsymman.2015.05.001. Epub 2015 May 21.
Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation.
To characterize hospices with high rates of problematic patterns of live discharges.
Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located.
In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers.
Problematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain.
关于临终关怀机构的现场出院情况如何因临终关怀机构提供者的税收状况和连锁关系而有所不同，目前所知甚少。
描述存在问题的现场出院模式发生率较高的临终关怀机构。
当机构发生率处于第90百分位数或更高时，三种临终关怀机构层面的现场出院模式被定义为有问题。一个临终关怀机构若有高比例的患者出院后住院，然后又重新入住临终关怀机构，则被认为具有有问题的现场出院模式，我们将其称为繁重的过渡。另外两种被研究的有问题的现场出院模式是临终关怀住院的前七天内现场出院以及临终关怀住院180天后现场出院。一个多变量逻辑模型研究了每种出院模式在临终关怀机构层面的发生率因临终关怀机构的连锁关系和盈利状况的差异。该模型还对医疗诊断的机构发生率、非白人患者、平均年龄以及临终关怀项目所在的州进行了调整。
2010年，3028个临终关怀项目有996,208例出院，其中18.0%的患者仍存活。每种提出的有问题的现场出院模式因连锁关系而异。没有连锁关系的营利性提供者比全国连锁的营利性提供者有更高的繁重过渡率（18.2%对12.1%，P<0.001），而非营利性提供者的繁重过渡率最低（1.4%）。约三分之一（33.8%）的营利性提供者表现出一种或多种这些出院模式，相比之下，非营利性提供者的这一比例为9.0%。
营利性提供者中存在问题的现场出院模式发生率较高，尤其是那些未与临终关怀连锁机构相关联的提供者。
