Madoka Family Clinic, Fukuoka, Japan.
Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Geriatr Gerontol Int. 2017 Nov;17(11):2247-2254. doi: 10.1111/ggi.12977. Epub 2017 Feb 8.
To quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients.
We carried out a case-control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care.
The case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95% CI 1.18-36.05), required assistance for activities of daily living (adjusted OR 3.61, 95% CI 1.12-10.51), non-use of oxygen inhalation therapy (adjusted OR 12.75, 95% CI 3.53-46.02), oral or suppository opioid use (adjusted OR 5.74, 95% CI 1.11-29.54) and transdermal patch opioid use (adjusted OR 8.30, 95% CI 1.97-34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95% CI 0.59-1.53). However, home care was significantly associated with a reduction of $7523 (95% CI $7093-7991, P = 0.015) in treatment costs.
Despite similar treatment durations between the groups, treatment costs were substantially lower in the home-care group. These findings might inform the policymaking process for improving the home-care support system. Geriatr Gerontol Int 2017; 17: 2247-2254.
量化终末期癌症患者家庭姑息治疗与住院姑息治疗的调整后成本差异。
我们开展了一项病例对照研究，纳入了 2009 年 1 月至 2013 年 12 月期间在家中死亡的家庭护理患者（病例），以及 2008 年 4 月至 2013 年 12 月期间在医院死亡的住院护理患者（对照）。从保险索赔数据和病历中获取患者特征数据。我们使用多变量逻辑回归分析确定家庭护理的决定因素。使用 Cox 比例风险分析来检查两种护理类型的治疗持续时间，并使用广义线性模型来估计与家庭护理相关的治疗成本降低。
病例组和对照组分别纳入了 48 名和 99 名患者。家庭护理与 1 名或多名与患者同住的人（调整后比值比 6.54，95%可信区间 1.18-36.05）、需要日常生活活动辅助（调整后比值比 3.61，95%可信区间 1.12-10.51）、不使用氧气吸入治疗（调整后比值比 12.75，95%可信区间 3.53-46.02）、口服或直肠用阿片类药物（调整后比值比 5.74，95%可信区间 1.11-29.54）和经皮贴剂阿片类药物（调整后比值比 8.30，95%可信区间 1.97-34.93）相关。家庭护理的调整后治疗持续时间比值比无显著意义（调整后比值比 0.95，95%可信区间 0.59-1.53）。然而，家庭护理与治疗成本显著降低 7523 美元（95%可信区间 7093-7991 美元，P = 0.015）相关。
尽管两组的治疗持续时间相似，但家庭护理组的治疗成本明显更低。这些发现可能为改善家庭护理支持系统的决策过程提供信息。国际老年医学和老年学杂志 2017；17：2247-2254。
