Wang Shi-Yi, Aldridge Melissa D, Canavan Maureen, Cherlin Emily, Bradley Elizabeth
Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; James J. Peters VA Medical Center, Bronx, New York, USA.
J Pain Symptom Manage. 2016 Dec;52(6):813-821. doi: 10.1016/j.jpainsymman.2016.05.031. Epub 2016 Sep 30.
Among the four levels of hospice care, continuous home care (CHC) is the most expensive care, and infrequently provided in practice.
To identify hospice and patient characteristics associated with the use of CHC and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment.
Using 100% fee-for-service Medicare claims data for beneficiaries aged 66 years or older who died between July and December 2011, we identified the percentage of hospice agencies in which patients used CHC in 2011 and determined hospice and patient characteristics associated with the use of CHC. Using multivariable analyses, we examined the associations between CHC utilization and hospice disenrollment and hospitalization after hospice enrollment, adjusted for hospice and patient characteristics.
Only 42.7% of hospices (1533 of 3592 hospices studied) provided CHC to at least one patient during the study period. Patients enrolled with for-profit, larger, and urban located hospices were more likely to use CHC (P < 0.001). Within these 1533 hospices, only 11.4% of patients used CHC. Patients who were white, had cancer, and had more comorbidities were more likely to use CHC. In multivariable models, compared with patients who did not use CHC, patients who used CHC were less likely to have hospice disenrollment (adjusted odds ratio 0.21; 95% CI 0.19, 0.23) and less likely to be hospitalized after hospice enrollment (adjusted odds ratio 0.37; 95% CI 0.34, 0.40).
Although a minority of patients uses CHC, such services may be protective against hospice disenrollment and hospitalization after hospice enrollment.
在临终关怀的四个级别中，持续居家护理（CHC）是最昂贵的护理方式，在实际中很少提供。
确定与使用CHC相关的临终关怀机构和患者特征，并研究CHC使用情况与临终关怀登记后退出临终关怀或住院之间的关联。
利用2011年7月至12月期间死亡的66岁及以上受益人的100%按服务收费的医疗保险索赔数据，我们确定了2011年患者使用CHC的临终关怀机构的百分比，并确定了与使用CHC相关的临终关怀机构和患者特征。使用多变量分析，我们研究了CHC使用情况与临终关怀登记后退出临终关怀和住院之间的关联，并根据临终关怀机构和患者特征进行了调整。
在研究期间，只有42.7%的临终关怀机构（3592家研究机构中的1533家）为至少一名患者提供了CHC。在营利性、规模较大且位于城市的临终关怀机构登记的患者更有可能使用CHC（P<0.001）。在这1533家临终关怀机构中，只有11.4%的患者使用了CHC。白人、患有癌症且合并症较多的患者更有可能使用CHC。在多变量模型中，与未使用CHC的患者相比，使用CHC的患者退出临终关怀的可能性较小（调整后的优势比为0.21；95%CI为0.19，0.23），且在临终关怀登记后住院的可能性较小（调整后的优势比为0.37；95%CI为0.34，0.40）。
尽管少数患者使用CHC，但此类服务可能有助于防止临终关怀登记后退出临终关怀和住院。
