Chang Hsiao-Ting, Chen Chun-Ku, Lin Ming-Hwai, Chou Pesus, Chen Tzeng-Ji, Hwang Shinn-Jang
From the Department of Family Medicine, Taipei Veterans General Hospital, and School of Medicine and Institute of Public Health and Community Medicine Research Center, National Yang-Ming University (H-TC); Department of Radiology, Taipei Veterans General Hospital, and School of Medicine and Institute of Clinical Medicine, National Yang-Ming University (C-KC); Department of Family Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University (M-HL and S-JH); Institute of Public Health and Community Medicine Research Center, National Yang-Ming University (PC); and Department of Family Medicine, Taipei Veterans General Hospital, and School of Medicine and Institute of Hospital and Health Care Administration, National Yang-Ming University (T-JC), Taipei, Taiwan.
Medicine (Baltimore). 2016 Feb;95(8):e2782. doi: 10.1097/MD.0000000000002782.
Few studies have reported on readmissions among cancer patients receiving inpatient palliative care (IPC). This study investigated readmissions in cancer patients after their first discharge from IPC in Taiwan from 2002 to 2010.This study was a secondary data analysis using information from the National Health Insurance Database in Taiwan from 2002 to 2010. We included subjects ≥20 years old diagnosed with malignant neoplasms who were listed in the registry of catastrophic illness. Patients diagnosed with cancer before January 1, 2002 or who had ever been admitted to an inpatient hospice palliative care unit before the study period were excluded. Readmission was defined as hospital readmission at least once after discharge from first admission to IPC until mortality or the end of the study period.A total of 42,022 patients who met the inclusion criteria were identified. The majority of these patients were male (60.4%). The mean age of cancer diagnosis was 64.0 ± 14.4 years for men and 64.5 ± 14.7 years for women. The mean age at first hospice ward admission was 65.2 ± 14.2 years for men and 65.9 ± 14.9 years for women. During their first admission to IPC, 59.2% patients died, and the median stay of first IPC admission was 8.0 days. Among those discharged alive from their first admission to IPC, 64.9% were readmitted, and 19.4% of these patients were readmitted on the same day of discharge. From first IPC discharge until mortality, 54.8% of patients were readmitted once, 23.9% were readmitted twice, 9.9% were readmitted 3 times, and 11.5% were readmitted 4 or more times. Being male, having a higher insurance premium level, having a longer length of stay during first IPC admission, being admitted to a teaching hospital, or being admitted to a tertiary hospital increased the adjusted hazard ratio for readmission.We found that terminal cancer patients in Taiwan received relatively late referrals for first admission to IPC and experienced a high rate of readmission after first discharge from IPC. Policies to improve hospice palliative care referrals and decrease readmissions should be considered.
很少有研究报道接受住院姑息治疗（IPC）的癌症患者再次入院情况。本研究调查了2002年至2010年台湾地区癌症患者首次从IPC出院后的再次入院情况。本研究是一项二次数据分析，使用了2002年至2010年台湾地区国民健康保险数据库中的信息。我们纳入了年龄≥20岁、被诊断为恶性肿瘤且列入重大疾病登记册的受试者。排除2002年1月1日前被诊断为癌症或在研究期间曾入住住院临终关怀姑息治疗病房的患者。再次入院定义为从首次入住IPC出院后至少有一次医院再入院，直至死亡或研究期结束。共识别出42,022名符合纳入标准的患者。这些患者大多数为男性（60.4%）。男性癌症诊断的平均年龄为64.0±14.4岁，女性为64.5±14.7岁。男性首次入住临终关怀病房的平均年龄为65.2±14.2岁，女性为65.9±14.9岁。在首次入住IPC期间，59.2%的患者死亡，首次入住IPC的中位住院时间为8.0天。在首次入住IPC后存活出院的患者中，64.9%再次入院，其中19.4%的患者在出院当天再次入院。从首次IPC出院至死亡，54.8%的患者再次入院1次，23.9%的患者再次入院2次，9.9%的患者再次入院3次，11.5%的患者再次入院4次或更多次。男性、保险费水平较高、首次入住IPC期间住院时间较长、入住教学医院或三级医院会增加再次入院的调整后风险比。我们发现台湾地区晚期癌症患者首次入住IPC的转诊相对较晚，且首次从IPC出院后再次入院率较高。应考虑制定改善临终关怀姑息治疗转诊和降低再次入院率的政策。
