Thygeson N Marcus, Wang Meinong, O'Riordan David, Pantilat Steven Z
1 Department of Healthcare Quality and Affordability, Blue Shield of California , San Francisco, California.
2 School of Public Health, Yale University , New Haven, Connecticut.
J Palliat Med. 2016 Dec;19(12):1281-1287. doi: 10.1089/jpm.2016.0176. Epub 2016 Aug 10.
California hospitals report palliative care (PC) program characteristics to the California Office of Statewide Health Planning and Development (OSHPD), but the significance of this information is unknown.
Our objective was to determine whether self-reported California hospital PC program characteristics are associated with lower end-of-life (EoL) Medicare utilization.
We performed a cross-sectional study of hospitals submitting 2012 data to OSHPD and included in the 2012 Dartmouth Atlas of Healthcare (DAHC) dataset, using statistical hypothesis testing, multivariate regression, and fuzzy set qualitative comparative analysis.
SETTING/SUBJECTS: Our analysis included 203 hospitals primarily providing general medical-surgical (GMS) care.
The following measures were available for each hospital: licensed GMS beds; type of control; presence of an inpatient or outpatient PC program; number of physicians, nurses, social workers, and chaplains on the PC team; number of PC-certified staff; percentage of Medicare decedents dying as inpatients; and average total hospital days, ICU days, and physician visits per Medicare decedent in the last six months of life.
Investor-owned hospitals have fewer PC programs and higher EoL utilization than do nonprofit hospitals. Among nonprofit hospitals, small size (substantially fewer than 150 medical-surgical beds), or large size and having an inpatient PC program with more than three PC staff per 100 GMS beds, or an interdisciplinary PC-certified team, is associated with significantly lower EoL hospital utilization and percentage of deaths occurring in the inpatient setting.
Improved program performance associated with higher staffing levels may be mediated by increased access to and earlier PC interventions.
California hospital-reported PC program characteristics are associated with significantly lower inpatient utilization by Medicare decedents.
加利福尼亚州的医院会向加利福尼亚州全州卫生规划与发展办公室（OSHPD）报告姑息治疗（PC）项目的特征，但这些信息的意义尚不清楚。
我们的目的是确定自我报告的加利福尼亚州医院PC项目特征是否与较低的临终（EoL）医疗保险利用率相关。
我们对向OSHPD提交2012年数据并包含在2012年达特茅斯医疗保健地图集（DAHC）数据集中的医院进行了横断面研究，采用统计假设检验、多元回归和模糊集定性比较分析。
设置/对象：我们的分析包括203家主要提供普通内科-外科（GMS）护理的医院。
每家医院可获得以下测量数据：持牌GMS病床数量；控制类型；是否存在住院或门诊PC项目；PC团队中医生、护士、社会工作者和牧师的数量；获得PC认证的工作人员数量；医疗保险死者住院死亡的百分比；以及每位医疗保险死者在生命最后六个月的平均总住院天数、重症监护病房天数和医生诊疗次数。
与非营利性医院相比，投资者所有的医院PC项目较少，EoL利用率较高。在非营利性医院中，规模较小（大大少于150张内科-外科病床），或规模较大且拥有每100张GMS病床配备超过三名PC工作人员的住院PC项目，或拥有跨学科PC认证团队，与EoL医院利用率显著降低以及住院环境中死亡百分比显著降低相关。
与更高人员配备水平相关的项目绩效改善可能是通过增加获得PC干预的机会和更早进行PC干预来实现的。
加利福尼亚州医院报告的PC项目特征与医疗保险死者的住院利用率显著降低相关。
