1 University of North Carolina School of Medicine , Chapel Hill, North Carolina.
2 University of North Carolina Lineberger Comprehensive Cancer Center , Chapel Hill, North Carolina.
J Palliat Med. 2018 Feb;21(2):216-219. doi: 10.1089/jpm.2016.0482. Epub 2017 Aug 16.
Cancer patients have a high rate of emergency department (ED) visits and inpatient hospitalizations (IHs) that may be reduced by use of outpatient palliative care services.
To determine whether the outpatient adult palliative care service at the University of North Carolina (UNC) Hospital, begun in 2008, reduced the frequency of ED visits and IH during a two-year period.
The charts of patients with lung cancer or head and neck cancer seen by the supportive care service from 2010 to 2011, and of a contemporaneous set of potential consults that were not seen, were retrospectively reviewed to determine the impact of this care delivery model.
SETTING/SUBJECTS: The number of individuals with lung cancer and head cancer seen during this two-year period was 24 and 23, respectively, permitting a statistical analysis from which meaningful conclusions could be drawn.
The frequency of ED visits and IHs for each patient was reviewed. Descriptive statistics were used. Fisher's exact test was used for data categorized into two by two contingency tables. The nonparametric Jonckheere-Terpstra method was used to test for ordered differences across categories.
Consultation with supportive care did not decrease overall use of ED visits. Patients with head and neck cancer showed an increase in ED visits (p = 0.08) but a reduction in inpatient admissions (p = 0.0004). In patients with lung cancer, the opposite effect was seen-an increase in inpatient visits (p = 0.02) but a decrease in ED visits. The frequency of ED visits was correlated with distance to the ED (p = 0.02), a finding that has not been noted before.
Further work is needed to define the best model for outpatient palliative care.
癌症患者急诊就诊和住院的频率较高，通过使用门诊姑息治疗服务可能会降低这一频率。
确定北卡罗来纳大学（UNC）医院 2008 年开设的成人门诊姑息治疗服务是否在两年内降低了急诊就诊和住院的频率。
回顾性分析了在 2010 年至 2011 年期间接受支持性护理服务的肺癌或头颈部癌症患者的病历，以及同期未接受咨询的潜在会诊患者的病历，以确定这种护理模式的影响。
地点/对象：在这两年期间，分别有 24 名和 23 名肺癌和头颈部癌症患者接受了治疗，允许进行统计分析，从而得出有意义的结论。
审查了每位患者的急诊就诊和住院频率。使用描述性统计数据。对于分为两类的二项式列联表数据，使用 Fisher 确切检验。使用非参数 Jonckheere-Terpstra 方法检验类别之间的有序差异。
姑息治疗咨询并未总体减少急诊就诊的使用。头颈部癌症患者的急诊就诊次数增加（p=0.08），但住院人数减少（p=0.0004）。在肺癌患者中，情况则相反，住院次数增加（p=0.02），但急诊就诊次数减少。急诊就诊的频率与到急诊的距离相关（p=0.02），这一发现以前尚未注意到。
需要进一步研究以确定最佳的门诊姑息治疗模式。
