Tanuseputro Peter, Beach Sarah, Chalifoux Mathieu, Wodchis Walter P, Hsu Amy T, Seow Hsien, Manuel Douglas G
Bruyère Research Institute, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.
PLoS One. 2018 Feb 15;13(2):e0191322. doi: 10.1371/journal.pone.0191322. eCollection 2018.
While most individuals wish to die at home, the reality is that most will die in hospital.
To determine whether receiving a physician home visit near the end-of-life is associated with lower odds of death in a hospital.
Observational retrospective cohort study, examining location of death and health care in the last year of life.
SETTING/PARTICIPANTS: Population-level study of Ontarians, a Canadian province with over 13 million residents. All decedents from April 1, 2010 to March 31, 2013 (n = 264,754).
More than half of 264,754 decedents died in hospital: 45.7% died in an acute care hospital and 7.7% in complex continuing care. After adjustment for multiple factors-including patient illness, home care services, and days of being at home-receiving at least one physician home visit from a non-palliative care physician was associated with a 47% decreased odds (odds-ratio, 0.53; 95%CI: 0.51-0.55) of dying in a hospital. When a palliative care physician specialist was involved, the overall odds declined by 59% (odds ratio, 0.41; 95%CI: 0.39-0.43). The same model, adjusting for physician home visits, showed that receiving palliative home care was associated with a similar reduction (odds ratio, 0.49; 95%CI: 0.47-0.51).
Location of death is strongly associated with end-of-life health care in the home. Less than one-third of the population, however, received end-of-life home care or a physician visit in their last year of life, revealing large room for improvement.
虽然大多数人希望在家中离世，但现实情况是大多数人会在医院死亡。
确定在生命末期接受医生家访是否与在医院死亡的几率降低有关。
观察性回顾性队列研究，考察生命最后一年的死亡地点和医疗保健情况。
地点/参与者：对安大略省居民进行的人群水平研究，安大略省是加拿大一个拥有超过1300万居民的省份。2010年4月1日至2013年3月31日期间的所有死者（n = 264,754）。
在264,754名死者中，超过一半在医院死亡：45.7%在急症护理医院死亡，7.7%在复杂的持续护理机构死亡。在对多种因素进行调整后——包括患者疾病、家庭护理服务以及在家天数——接受至少一次非姑息治疗医生的家访与在医院死亡的几率降低47%相关（优势比，0.53；95%置信区间：0.51 - 0.55）。当有姑息治疗医生参与时，总体几率下降了59%（优势比，0.41；95%置信区间：0.39 - 0.43）。在对医生家访进行调整的同一模型中，接受姑息家庭护理与类似的降低相关（优势比，0.49；95%置信区间：0.47 - 0.51）。
死亡地点与生命末期在家中的医疗保健密切相关。然而，不到三分之一的人口在生命的最后一年接受了生命末期的家庭护理或医生家访，这表明有很大的改进空间。
