Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
BMJ. 2018 Apr 11;361:k1161. doi: 10.1136/bmj.k1161.
To compare the delivery of end of life care given to US Medicare beneficiaries in hospital by internal medicine physicians with Republican versus Democrat political affiliations.
Retrospective observational study.
US Medicare.
Random sample of Medicare beneficiaries, who were admitted to hospital in 2008-12 with a general medical condition, and died in hospital or shortly thereafter.
Total inpatient spending, intensive care unit use, and intensive end of life treatments (eg, mechanical ventilation and gastrostomy tube insertion) among patients dying in hospital, and hospice referral among patients discharged but at high predicted risk of 30 day mortality after discharge. Physicians were categorized as Democrat, Republican, or non-donors, using federal political contribution data.
Among 1 480 808 patients, 93 976 (6.3%) were treated by 1523 Democratic physicians, 58 876 (4.0%) by 768 Republican physicians, and 1 327 956 (89.6%) by 23 627 non-donor physicians. Patient demographics and clinical characteristics were similar between groups. Democrat physicians were younger, more likely to be female, and more likely to have graduated from a top 20 US medical school than Republican physicians. Mean end of life spending, after adjustment for patient covariates and hospital specific fixed effects, was US$17 938 (£12 872; €14 612) among Democrat physicians (95% confidence interval $17 176 to $18 700) and $18 409 among Republican physicians ($17 362 to $19 456; adjusted Republican Democrat difference, $472 (-$803 to $1747), P=0.47). Intensive end of life treatments for patients who died in hospital did not vary by physician political affiliation. The proportion of patients discharged from hospital to hospice did not vary with physician political affiliation. Among patients in the top 5% of predicted risk of death 30 days after hospital discharge, adjusted proportions of patients discharged to hospice were 15.8%, 15.0%, and 15.2% among Democrat, Republican, and non-donor physicians, respectively (adjusted difference in proportion between Republicans Democrats, -0.8% (-2.7% to 0.9%), P=0.43).
This study provided no evidence that physician political affiliation is associated with the intensity of end of life care received by patients in hospital. Other treatments for politically polarised healthcare issues should be investigated.
比较美国医疗保险受益人的临终关怀服务，这些受益人为内科医生，他们的政治派别为共和党或民主党。
回顾性观察性研究。
美国医疗保险。
2008-12 年因一般医疗状况住院、在医院死亡或随后不久在医院死亡的医疗保险受益人的随机样本。
住院患者的总住院费用、重症监护病房的使用情况以及重症末期的治疗（如机械通气和胃造口管插入术），以及出院后但预测 30 天后死亡率高的患者的临终关怀转介情况。使用联邦政治捐款数据将医生分为民主党人、共和党人和非捐赠者。
在 1480808 名患者中，有 93976 名（6.3%）由 1523 名民主党医生治疗，58876 名（4.0%）由 768 名共和党医生治疗，1327956 名（89.6%）由 23627 名非捐赠医生治疗。各组患者的人口统计学和临床特征相似。与共和党医生相比，民主党医生更年轻，更有可能是女性，并且更有可能毕业于美国前 20 名的医学院。在调整了患者协变量和医院特定固定效应后，民主党医生的临终护理费用为 17938 美元（12872 英镑；14612 欧元）（95%置信区间为 17176 美元至 18700 美元），共和党医生的费用为 18409 美元（17362 美元至 19456 美元；调整后的共和党与民主党差异为 472 美元（-803 美元至 1747 美元），P=0.47）。在因住院死亡的患者中，接受的临终治疗方式不因医生的政治派别而异。从医院出院接受临终关怀的患者比例与医生的政治派别无关。在出院后 30 天死亡风险最高的前 5%的患者中，调整后的出院至临终关怀的患者比例分别为 15.8%、15.0%和 15.2%，分别为民主党、共和党和非捐赠医生（调整后的共和党与民主党差异为-0.8%（-2.7%至 0.9%），P=0.43）。
本研究没有证据表明医生的政治派别与住院患者接受的临终关怀强度有关。其他针对政治两极化医疗保健问题的治疗方法应进行调查。
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