Wilson Donna M, Shen Ye, Birch Stephen
1 Faculty of Nursing, University of Alberta , Edmonton, Canada .
2 School of Public Health, University of Alberta , Edmonton, Canada .
J Palliat Med. 2017 Jul;20(7):752-758. doi: 10.1089/jpm.2016.0490. Epub 2017 Mar 10.
Long-standing concern exists over hospital use by people near or at the end of life (EOL) related to the appropriateness, quality, and cost of care in hospital. It is widely believed that most people die in hospital after an escalation in hospital use over the last year of life. As most deaths in high-income countries are not sudden or unexpected, opportunities exist for planning compassionate, effective, and evidence-based EOL care.
Gain current population-based evidence for EOL health policy and services planning.
Retrospective study of population-based hospital utilization data.
SETTING/SUBJECTS: All hospital patients in every Canadian province and territory except Quebec. All decedents with hospital separations in 2014-2015.
Descriptive-comparative and logical regression analysis tests.
In 2014-2015, 3.5% of hospital episodes ended in death and 43.7% of all deaths in Canada (excluding Quebec) took place in hospital. 95.2% of those dying in hospital were only admitted once or twice during their last 365 days of life. 3.6% of those dying in hospital had been living in the community and receiving publicly funded home care before the hospital admission that ended in death, while 67.0% had been living at home without home care. 79.0% of hospital deaths followed an unplanned admission through the emergency room, with 70.5% arriving by ambulance. The hospital care provided in the last stay was largely noninterventionist.
These findings reveal the need for a major reconceptualization of death, dying, and EOL care to ensure sufficient capacity of palliative home care and other services to support dying people and prevent the health and family caregiver crises that lead to hospital-based EOL care and death.
长期以来，人们一直关注临终（EOL）患者或接近临终患者的住院情况，这与医院护理的适宜性、质量和成本有关。人们普遍认为，大多数人在生命的最后一年住院次数增加后在医院死亡。由于高收入国家的大多数死亡并非突然或意外，因此存在规划富有同情心、有效且基于证据的临终护理的机会。
获取基于当前人群的证据，以用于临终健康政策和服务规划。
基于人群的医院利用数据的回顾性研究。
地点/研究对象：除魁北克省外的加拿大每个省和地区的所有住院患者。2014 - 2015年所有出院的死者。
描述性比较和逻辑回归分析测试。
在2014 - 2015年，3.5%的住院病例以死亡告终，加拿大（不包括魁北克省）所有死亡病例中有43.7%在医院发生。在医院死亡的患者中，95.2%在生命的最后365天内仅住院一两次。在医院死亡的患者中，3.6%在导致死亡的住院前一直生活在社区并接受公共资助的家庭护理，而67.0%一直居家且未接受家庭护理。79.0%的医院死亡病例是通过急诊室非计划入院的，其中70.5%是乘坐救护车入院。最后一次住院期间提供的医院护理在很大程度上是非干预性的。
这些发现表明，需要对死亡、临终和临终护理进行重大重新概念化，以确保有足够的姑息性家庭护理和其他服务能力来支持临终患者，并预防导致基于医院的临终护理和死亡的健康及家庭护理危机。
