Unroe Kathleen T, Bernard Brittany, Stump Timothy E, Tu Wanzhu, Callahan Christopher M
Indiana University Center for Aging Research, Indianapolis, Indiana.
Regenstrief Institute, Inc., Indianapolis, Indiana.
J Am Geriatr Soc. 2017 Jul;65(7):1490-1496. doi: 10.1111/jgs.14826. Epub 2017 Mar 14.
To describe differences in hospice services for patients living at home, in nursing homes or in assisted living facilities, including the overall number and duration of visits by different hospice care providers across varying lengths of stay.
Retrospective cohort study using hospice patient electronic medical record data.
Large, national hospice provider.
Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed.
Descriptive statistics were calculated for utilization measures for each type of provider and by location of care. Frequency and duration of service contacts were standardized to a 1 week period and pairwise comparisons were used to detect differences in care provided between the three settings.
Minimal differences were found in overall intensity of service contacts across settings, however, the mix of services were different for patients living at home versus nursing home versus assisted living facility. Overall, more nurse care was provided at the beginning and end of the hospice episode; intensity of aide care services was higher in the middle portion of the hospice episode. Nearly 43% of the sample had hospice stays less than 2 weeks and up to 20% had stays greater than 6 months.
There are significant differences between characteristics of hospice patients in different settings, as well as the mix of services they receive. Medicare hospice payment methodology was revised starting in 2016. While the new payment structure is in greater alignment with the U shape distribution of services, it will be important to evaluate the impact of the new payment methodology on length of stay and mix of services by different providers across settings of care.
描述在家中、养老院或辅助生活设施中居住的临终关怀患者所接受的临终关怀服务差异，包括不同临终关怀护理提供者在不同住院时长内的探访总次数和时长。
使用临终关怀患者电子病历数据进行回顾性队列研究。
大型全国性临终关怀服务提供商。
分析了2009年至2014年期间接受常规临终关怀护理的32,605名临终关怀患者的数据。
计算每种类型提供者以及按护理地点划分的利用指标的描述性统计数据。将服务接触的频率和时长标准化为1周时间段，并使用成对比较来检测三种护理环境之间提供的护理差异。
不同环境下服务接触的总体强度差异极小，然而，在家中、养老院和辅助生活设施中居住的患者所接受的服务组合有所不同。总体而言，在临终关怀期间的开始和结束阶段提供了更多的护士护理；在临终关怀期间的中间阶段，护工护理服务强度更高。近43%的样本临终关怀住院时长少于2周，高达20%的样本住院时长超过6个月。
不同环境下临终关怀患者的特征以及他们所接受的服务组合存在显著差异。医疗保险临终关怀支付方法于2016年开始修订。虽然新的支付结构与服务的U形分布更趋一致，但评估新支付方法对不同提供者在不同护理环境下的住院时长和服务组合的影响将非常重要。
