Zalenski Robert J, Jones Spencer S, Courage Cheryl, Waselewsky Denise R, Kostaroff Anna S, Kaufman David, Beemath Afzal, Brofman John, Castillo James W, Krayem Hicham, Marinelli Anthony, Milner Bradley, Palleschi Maria Teresa, Tareen Mona, Testani Sheri, Soubani Ayman, Walch Julie, Wheeler Judy, Wilborn Sonali, Granovsky Hanna, Welch Robert D
Wayne State University, Detroit, Michigan, USA; Tenet Healthcare, Dallas, Texas, USA.
Tenet Healthcare, Dallas, Texas, USA.
J Pain Symptom Manage. 2017 Jan;53(1):5-12.e3. doi: 10.1016/j.jpainsymman.2016.08.003. Epub 2016 Oct 5.
There are few multicenter studies that examine the impact of systematic screening for palliative care and specialty consultation in the intensive care unit (ICU).
To determine the outcomes of receiving palliative care consultation (PCC) for patients who screened positive on palliative care referral criteria.
In a prospective quality assurance intervention with a retrospective analysis, the covariate balancing propensity score method was used to estimate the conditional probability of receiving a PCC and to balance important covariates. For patients with and without PCCs, outcomes studied were as follows: 1) change to "do not resuscitate" (DNR), 2) discharge to hospice, 3) 30-day readmission, 4) hospital length of stay (LOS), 5) total direct hospital costs.
In 405 patients with positive screens, 161 (40%) who received a PCC were compared to 244 who did not. Patients receiving PCCs had higher rates of DNR-adjusted odds ratio (AOR) = 7.5; 95% CI 5.6-9.9) and hospice referrals-(AOR = 7.6; 95% CI 5.0-11.7). They had slightly lower 30-day readmissions-(AOR = 0.7; 95% CI 0.5-1.0); no overall difference in direct costs or LOS was found between the two groups. When patients receiving PCCs were stratified by time to PCC initiation, early consultation-by Day 4 of admission-was associated with reductions in LOS (1.7 days [95% CI -3.1, -1.2]) and average direct variable costs (-$1815 [95% CI -$3322, -$803]) compared to those who received no PCC.
Receiving a PCC in the ICUs was significantly associated with more frequent DNR code status and hospice referrals, but not 30-day readmissions or hospital utilization. Early PCC was associated with significant LOS and direct cost reductions. Providing PCC early in the ICU should be considered.
很少有多中心研究探讨重症监护病房（ICU）中系统的姑息治疗筛查和专科会诊的影响。
确定在姑息治疗转诊标准筛查中呈阳性的患者接受姑息治疗会诊（PCC）的结果。
在一项采用回顾性分析的前瞻性质量保证干预中，使用协变量平衡倾向评分方法来估计接受PCC的条件概率并平衡重要协变量。对于接受和未接受PCC的患者，研究的结果如下：1）改为“不进行心肺复苏”（DNR），2）转至临终关怀机构，3）30天再入院，4）住院时间（LOS），5）医院直接总成本。
在405例筛查呈阳性的患者中，161例（40%）接受了PCC，与244例未接受PCC的患者进行比较。接受PCC的患者DNR调整优势比（AOR）更高（AOR = 7.5；95% CI 5.6 - 9.9），临终关怀转诊率也更高（AOR = 7.6；95% CI 5.0 - 11.7）。他们的30天再入院率略低（AOR = 0.7；95% CI 0.5 - 1.0）；两组之间在直接成本或住院时间方面未发现总体差异。当按开始PCC的时间对接受PCC的患者进行分层时，与未接受PCC的患者相比，入院第4天前的早期会诊与住院时间缩短（1.7天[95% CI -3.1，-1.2]）和平均直接可变成本降低（-1815美元[95% CI -3322美元，-803美元]）相关。
在ICU接受PCC与更频繁的DNR代码状态和临终关怀转诊显著相关，但与30天再入院或医院利用率无关。早期PCC与显著缩短住院时间和降低直接成本相关。应考虑在ICU早期提供PCC。
