预测临终前一年患有痴呆症的人到急诊科就诊的因素：使用临床和行政数据链接的回顾性队列研究。
Predictors of emergency department attendance by people with dementia in their last year of life: Retrospective cohort study using linked clinical and administrative data.
机构信息
Cicely Saunders Institute, Policy and Rehabilitation, King's College London, London, United Kingdom.
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
出版信息
Alzheimers Dement. 2018 Jan;14(1):20-27. doi: 10.1016/j.jalz.2017.06.2267. Epub 2017 Aug 22.
INTRODUCTION
A fall in hospital deaths in dementia has been interpreted as indicating an improvement in end-of-life care. Whether other indicators of quality of end-of-life care, such as emergency department (ED) attendance, show a similar trend is unclear.
METHODS
Retrospective cohort study using electronic medical records from a large mental health care provider, linked to national mortality and hospital use data (2008-2013).
RESULTS
Of 4867 patients, 78.6% (3824) had at least one ED attendance during their last year of life (mean 2.13, standard deviation 2.34, range 0-54). ED attendance increased over the time period (incidence rate ratio 1.62, 95% confidence interval 1.46-1.80 for 2012-2013 compared with 2008-2009).
DISCUSSION
ED attendance in the last year of life for people with dementia is common and is increasing. Policy makers must pay attention to a broader range of indicators of poor end-of-life care alongside the place of death.
简介
医院痴呆症死亡人数的下降被解读为临终关怀质量的提高。其他临终关怀质量指标，如急诊科（ED）就诊情况是否也呈现出类似趋势尚不清楚。
方法
这是一项使用大型精神卫生服务提供者的电子病历进行的回顾性队列研究，并与国家死亡率和医院使用数据（2008-2013 年）相关联。
结果
在 4867 名患者中，78.6%（3824 人）在生命的最后一年至少有一次 ED 就诊（平均 2.13，标准差 2.34，范围 0-54）。ED 就诊的次数随着时间的推移而增加（2012-2013 年与 2008-2009 年相比，发病率比为 1.62，95%置信区间为 1.46-1.80）。
讨论
痴呆症患者在生命的最后一年中经常去 ED 就诊，而且这一比例还在增加。政策制定者必须关注更广泛的临终关怀质量指标，而不仅仅是死亡地点。
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