Keele Linda, Keenan Heather T, Bratton Susan L
1 Department of Anesthesia and Critical Care, Valley Children's Hospital , Fresno, California.
2 Department of Pediatrics, Division of Critical Care, University of Utah , Salt Lake City, Utah.
J Palliat Med. 2016 Mar;19(3):286-91. doi: 10.1089/jpm.2015.0261. Epub 2015 Dec 15.
The American Academy of Pediatrics (AAP) and the American Academy of Hospice and Palliative Medicine (AAHPM) have recommended minimal standards for palliative care (PC) team composition and availability. It is unknown whether team composition affects utilization of PC.
The study objective was to describe pediatric PC team composition, evaluate whether composition and availability are associated with utilization, and examine PC referral patterns.
The study was a descriptive survey. Subjects were pediatric PC team directors or hospital administrators at Pediatric Health Information System (PHIS) hospitals (N = 44).
The overall response rate was 86%. Teams varied in size from <1 to 9 full-time members. Average referrals per hospital bed were 0.46, range 0.05-2.13. Among individual PC team roles, referral rates were 34% greater in teams with an advanced nurse practitioner (ANP) (p = 0.07). Likewise, teams with acute pain, chronic pain, or hospice palliative medicine specialists tended to have greater referral rates (39%, 36%, and 25%), though reported differences were not statistically significant. Teams adherent to the original AAP recommendations had a 31% greater referral rate (p = 0.22). Teams available 24 hours daily had similar referral rates to those with less availability (0.47 versus 0.46 [p = 0.94]).
Team composition and availability are not crucial to PC utilization. Hospitals with some personnel but not all recommended team members should create formal teams and modify them over time. The addition of team members that tend to increase referrals, namely ANPs and acute pain, chronic pain, or hospice palliative medicine specialists, should be considered.
美国儿科学会（AAP）和美国临终关怀与姑息医学学会（AAHPM）已经推荐了姑息治疗（PC）团队组成和可用性的最低标准。尚不清楚团队组成是否会影响PC的利用率。
本研究的目的是描述儿科PC团队的组成，评估组成和可用性是否与利用率相关，并检查PC转诊模式。
该研究为描述性调查。研究对象是儿科健康信息系统（PHIS）医院（N = 44）的儿科PC团队主任或医院管理人员。
总体回复率为86%。团队规模从少于1名到9名全职成员不等。每张医院病床的平均转诊率为0.46，范围为0.05 - 2.13。在PC团队的各个角色中，拥有高级执业护士（ANP）的团队转诊率高34%（p = 0.07）。同样，拥有急性疼痛、慢性疼痛或临终关怀姑息医学专家的团队转诊率往往更高（分别为39%、36%和25%），尽管报告的差异无统计学意义。遵循AAP原始建议的团队转诊率高31%（p = 0.22）。每天24小时可用的团队与可用性较低的团队转诊率相似（0.47对0.46 [p = 0.94]）。
团队组成和可用性对PC的利用率并非至关重要。有部分人员但并非所有推荐团队成员的医院应组建正式团队并随着时间推移进行调整。应考虑增加那些往往会提高转诊率的团队成员，即高级执业护士以及急性疼痛、慢性疼痛或临终关怀姑息医学专家。
