Yim Cindi K, Barrón Yolanda, Moore Stanley, Murtaugh Chris, Lala Anuradha, Aldridge Melissa, Goldstein Nathan, Gelfman Laura P
From the Division of Cardiology and Population Health Science and Policy (A.L.) and Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai (M.A., N.G., L.P.G.), New York, NY; Icahn School of Medicine at Mount Sinai, New York, NY (C.K.Y.); Center for Home Care Policy and Research, Visiting Nurse Service of New York, NY (Y.B., C.M.); and Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY (M.A., L.P.G.). S. Moore is an independent contractor in Bonny Doon, CA.
Circ Heart Fail. 2017 Mar;10(3). doi: 10.1161/CIRCHEARTFAILURE.116.003335.
Patients with advanced heart failure (HF) enroll in hospice at low rates, and data on their acute medical service utilization after hospice enrollment is limited.
We performed a descriptive analysis of Medicare fee-for-service beneficiaries, with at least one home health claim between July 1, 2009, and June 30, 2010, and at least 2 HF hospitalizations between July 1, 2009, and December 31, 2009, who subsequently enrolled in hospice between July 1, 2009, and December 31, 2009. We estimated panel-negative binomial models on a subset of beneficiaries to compare their acute medical service utilization before and after enrollment. Our sample size included 5073 beneficiaries: 55% were female, 45% were ≥85 years of age, 13% were non-white, and the mean comorbidity count was 2.38 (standard deviation 1.22). The median number of days between the second HF hospital discharge and hospice enrollment was 45. The median number of days enrolled in hospice was 15, and 39% of the beneficiaries died within 7 days of enrollment. During the study period, 11% of the beneficiaries disenrolled from hospice at least once. The adjusted mean number of hospital, intensive care unit, and emergency room admissions decreased from 2.56, 0.87, and 1.17 before hospice enrollment to 0.53, 0.19, and 0.76 after hospice enrollment.
Home health care Medicare beneficiaries with advanced HF who enrolled in hospice had lower acute medical service utilization after their enrollment. Their pattern of hospice use suggests that earlier referral and improved retention may benefit this population. Further research is necessary to understand hospice referral and palliative care needs of advanced HF patients.
晚期心力衰竭（HF）患者进入临终关怀的比例较低，且关于他们进入临终关怀后急性医疗服务利用情况的数据有限。
我们对2009年7月1日至2010年6月30日期间至少有一次家庭健康索赔、2009年7月1日至2009年12月31日期间至少有2次HF住院且随后于2009年7月1日至2009年12月31日期间进入临终关怀的医疗保险按服务收费受益人进行了描述性分析。我们在一部分受益人中估计了面板负二项式模型，以比较他们入组前后的急性医疗服务利用情况。我们的样本量包括5073名受益人：55%为女性，45%年龄≥85岁，13%为非白人，合并症平均计数为2.38（标准差1.22）。第二次HF出院与进入临终关怀之间的中位天数为45天。进入临终关怀的中位天数为15天，39%的受益人在入组后7天内死亡。在研究期间，11%的受益人至少有一次退出临终关怀。调整后的医院、重症监护病房和急诊室入院平均次数从临终关怀入组前的2.56、0.87和1.17降至入组后的0.53、0.19和0.76。
进入临终关怀的晚期HF家庭健康护理医疗保险受益人在入组后急性医疗服务利用较低。他们的临终关怀使用模式表明，更早的转诊和更好的留存率可能使这一人群受益。有必要进行进一步研究以了解晚期HF患者的临终关怀转诊和姑息治疗需求。
