Youens David, Moorin Rachael
1 Health Systems and Health Economics, School of Public Health, Curtin University , Bentley, Australia .
2 Centre for Health Services Research, School of Population Health, The University of Western Australia , Crawley, Australia .
J Palliat Med. 2017 Jul;20(7):736-744. doi: 10.1089/jpm.2016.0417. Epub 2017 Feb 16.
Community-based palliative care may potentially benefit patients by offering their preferred care at the end of life and benefit systems by reducing hospital use.
To compare place of death and acute care hospital use in the last year of life between cancer decedents who did and did not access a community-based palliative care service (PCS).
Retrospective observational cohort study using linked individual administrative records from cancer registry, hospital, emergency department (ED), mortality, and PCS databases. Propensity score-weighted regression methods were used.
SETTING/SUBJECTS: Whole of population study incorporating 28,561 West Australian cancer decedents from 2001 to 2011.
Exposure was defined as ever/never accessed PCS. Outcomes were place of death (in/out of hospital) and the number, length of stay, and cumulative cost of hospital admissions at the end of life.
Decedents who accessed the service (n = 16,530) had triple (adjusted odds ratio 3.19 [3.01-3.38]) the odds of dying out of hospital compared with those who did not. Unplanned hospitalizations were reduced in the last year (adjusted incidence rate ratio [IRR] 0.94 [0.91-0.97]) and last week of life (adjusted [IRR] 0.35 [0.33-0.38]), as were ED presentations (adjusted RR 0.92 [0.98-0.95], adjusted RR 0.26 [0.23-0.28]) in the last year and last week of life, respectively. There were significant reductions in average total bed days (-7.60 [-8.34 to -6.87]) and acute care costs (-A$5,491 [-A$6,155 to -A$4,827]) over the last year of life.
In addition to supporting people to die out of hospital, PCS was associated with reduced acute care admissions, bed days, and costs over the last year of life. The provision of high-quality palliative care in the community alleviates the burden on acute care hospitals and, thus, may partially offset public funding of this model.
基于社区的姑息治疗可能通过在生命末期提供患者偏好的护理而使患者受益，并通过减少医院使用而使医疗系统受益。
比较使用和未使用基于社区的姑息治疗服务（PCS）的癌症死者在生命最后一年的死亡地点和急性护理医院使用情况。
回顾性观察队列研究，使用来自癌症登记、医院、急诊科（ED）、死亡率和PCS数据库的关联个人行政记录。采用倾向评分加权回归方法。
设置/研究对象：对2001年至2011年西澳大利亚州的28561名癌症死者进行全人群研究。
暴露定义为是否使用过PCS。结局指标为死亡地点（医院内/医院外）以及生命末期的住院次数、住院时长和累计住院费用。
使用该服务的死者（n = 16530）在医院外死亡的几率是未使用者的三倍（调整后的优势比为3.19 [3.01 - 3.38]）。在生命的最后一年（调整后的发病率比[IRR]为0.94 [0.91 - 0.97]）和生命的最后一周（调整后的[IRR]为0.35 [0.33 - 0.38]），非计划性住院次数减少，在生命的最后一年和最后一周，急诊科就诊次数也分别减少（调整后的相对危险度为0.92 [0.98 - 0.95]，调整后的相对危险度为0.26 [0.23 - 0.28]）。在生命的最后一年，平均总住院天数（-7.60 [-8.34至-6.87]）和急性护理费用（-5491澳元[-6155至-4827澳元]）显著降低。
除了支持患者在医院外死亡外，PCS还与生命最后一年急性护理入院次数、住院天数和费用的减少相关。在社区提供高质量的姑息治疗减轻了急性护理医院的负担，因此可能部分抵消该模式的公共资金投入。
