Tan Woan Shin, Lee Angel, Yang Sze Yee, Chan Susan, Wu Huei Yaw, Ng Charis Wei Ling, Heng Bee Hoon
Health Services & Outcomes Research Department, National Healthcare Group, Singapore
Palliative Medicine Department, Tan Tock Seng Hospital, Singapore Dover Park Hospice, Singapore.
Palliat Med. 2016 Jul;30(7):634-41. doi: 10.1177/0269216315622126. Epub 2016 Feb 11.
Terminally ill patients at the end-of-life do transit between care settings due to their complex care needs. Problems of care fragmentation could result in poor quality of care.
We aimed to evaluate the impact of an integrated hospice home care programme on acute care service usage and on the share of home deaths.
SETTINGS/PARTICIPANTS: The retrospective study cohort comprised patients who were diagnosed with cancer, had an expected prognosis of 1 year or less, and were referred to a home hospice. The intervention group comprised deceased patients enrolled in the integrated hospice home care programme between September 2012 and June 2014. The historical comparison group comprised deceased patients who were referred to other home hospices between January 2007 and January 2011.
There were 321 cases and 593 comparator subjects. Relative to the comparator group, the share of hospital deaths was significantly lower for programme participants (12.1% versus 42.7%). After adjusting for differences at baseline, the intervention group had statistically significantly lower emergency department visits at 30 days (incidence rate ratio: 0.38; 95% confidence interval: 0.31-0.47), 60 days (incidence rate ratio: 0.61; 95% confidence interval: 0.54-0.69) and 90 days (incidence rate ratio: 0.69; 95% confidence interval: 0.62-0.77) prior to death. Similar results held for the number of hospitalisations at 30 days (incidence rate ratio: 0.48; 95% confidence interval: 0.40-0.58), 60 days (incidence rate ratio: 0.71; 95% confidence interval: 0.62-0.82) and 90 days (incidence rate ratio: 0.77; 95% confidence interval: 0.68-0.88) prior to death.
Our results demonstrated that by integrating services between acute care and home hospice care, a reduction in acute care service usage could occur.
临终的晚期患者因其复杂的护理需求，确实会在不同护理机构之间转移。护理碎片化问题可能导致护理质量低下。
我们旨在评估综合临终关怀家庭护理计划对急性护理服务使用情况以及在家中死亡比例的影响。
设置/参与者：回顾性研究队列包括被诊断患有癌症、预期预后为1年或更短时间且被转介至家庭临终关怀机构的患者。干预组包括2012年9月至2014年6月期间纳入综合临终关怀家庭护理计划的已故患者。历史对照组包括2007年1月至2011年1月期间被转介至其他家庭临终关怀机构的已故患者。
有321例病例和593名对照对象。与对照组相比，该计划参与者的医院死亡比例显著更低（12.1%对42.7%）。在对基线差异进行调整后，干预组在死亡前30天（发病率比：0.38；95%置信区间：0.31 - 0.47）、60天（发病率比：0.61；95%置信区间：0.54 - 0.69）和90天（发病率比：0.69；95%置信区间：0.62 - 0.77）的急诊就诊次数在统计学上显著更低。在死亡前30天（发病率比：0.48；95%置信区间：0.40 - 0.58）、60天（发病率比：0.71；95%置信区间：0.62 - 0.82）和90天（发病率比：0.77；95%置信区间：0.68 - 0.88）的住院次数也有类似结果。
我们的结果表明，通过整合急性护理和家庭临终关怀护理之间的服务，可以减少急性护理服务的使用。
