Dipartimento Interaziendale della Fragilità (DIFRA) of the Health Local Unit of Lecco, Lecco, Italy.
Servizio di Epidemiologia e Programmazione, Dipartimento Programmazione, Acquisto e Controllo of the Health Local Unit of Lecco, Lecco, Italy.
Eur J Public Health. 2017 Feb 1;27(1):25-30. doi: 10.1093/eurpub/ckw152.
Over one quarter of the health care expenditures is estimated to be spent for patients in the last year of life (LYL). For these patients, palliative care (PC) has been suggested as a response for improving the standards of care and reducing health costs. The aim of this study was to analyze a cohort of LYL people, in terms of comparing hospitalised patients who had been referred for PC to patients receiving usual care (UC). Retrospective study carried out on patients resident in Lecco (Italy) who died between 2012 and 2013. Records of patients were obtained from the Death certificate registry and cross-linked with Regional Healthcare Information System, Hospital Discharge Records and Palliative Care Registry A total of 5830 patients were analyzed. At least one hospitalization was reported by 2586 (44.3%) patients in the last month of life and 3957 (67.9%) patients in the last year of life. A total of 1114 (19.1%) patients were referred to palliative care with median duration of enrollment of 31 days (IQR = 11–69). PC was found to decrease the risk of hospital admission (adj-OR = 0.21; 95% CI = 0.18–0.26) and dying in hospital (adj-OR = 0.03; 95% CI = 0.02–0.04). Patients in the last year of life show a high risk of hospitalization, which represents a substantial component of health-care costs. Our study suggests that home PC consultation could represent an important public health strategy in order to lower hospital costs for LYL patients and reduce the probability of dying in hospital.
据估计，超过四分之一的医疗保健支出用于生命最后一年（LYL）的患者。对于这些患者，姑息治疗（PC）已被提议作为提高护理标准和降低医疗成本的一种应对措施。本研究的目的是分析一组 LYL 患者，比较已转介姑息治疗的住院患者与接受常规护理（UC）的患者。这是一项在意大利莱科（Lecco）居住的在 2012 年至 2013 年期间死亡的患者中进行的回顾性研究。从死亡证明登记处和区域医疗保健信息系统、住院记录和姑息治疗登记处获得患者的记录。共分析了 5830 名患者。在生命的最后一个月，至少有一次住院记录的患者有 2586 名（44.3%），在生命的最后一年有 3957 名（67.9%）。共有 1114 名（19.1%）患者被转介到姑息治疗，登记的中位时间为 31 天（IQR = 11-69）。姑息治疗降低了住院的风险（调整后的 OR = 0.21；95%CI = 0.18-0.26）和死于医院的风险（调整后的 OR = 0.03；95%CI = 0.02-0.04）。生命最后一年的患者有很高的住院风险，这是医疗保健成本的一个重要组成部分。我们的研究表明，家庭姑息治疗咨询可能是降低 LYL 患者住院费用和降低在医院死亡概率的重要公共卫生策略。
