Khateeb Rafina, Puelle Margaret R, Firn Janice, Saul D'Anna, Chang Robert, Min Lillian
1 University of Michigan, Ann Arbor, MI.
2 University of Michigan Medical School, Ann Arbor, MI.
Am J Med Qual. 2018 Nov/Dec;33(6):569-575. doi: 10.1177/1062860618768069. Epub 2018 Apr 12.
Despite known benefits, palliative care (PC) consultation for hospitalized patients remains underutilized. The objective was to improve frequency and timeliness of appropriate inpatient PC consultation. On 2 of 11 hospitalist teams, a PC representative attended discharge rounds twice a week. Control teams' discharge rounds were unenhanced. Subjects were all patients admitted to a hospitalist service in a quaternary academic medical center. The primary outcome was change in provision of PC consultation over time; the secondary outcome was change in time-to-consult (days). Hospitalists were surveyed regarding the intervention. The unadjusted proportion of patients receiving PC consultation increased from 2.7% to 5.2% on the intervention teams. Compared to control teams over time and adjusting for multiple covariates, the intervention increased PC consultation (difference-in-difference [DID] = 1.0 percentage-point increase [95% CI = 0.3%-1.8%]) and decreased time to consult (DID = -5 days [95% CI = -11 to -1]) in patients admitted for noncancer diagnoses. Hospitalists thought the intervention facilitated effective patient care without increased burden.
尽管已知有诸多益处，但针对住院患者的姑息治疗（PC）会诊仍未得到充分利用。目标是提高适当的住院患者PC会诊的频率和及时性。在11个住院医师团队中的2个团队，一名PC代表每周参加两次出院查房。对照组团队的出院查房未作强化。研究对象为一家四级学术医疗中心所有入住住院医师服务科室的患者。主要结局是随时间推移PC会诊提供情况的变化；次要结局是会诊时间（天数）的变化。就该干预措施对住院医师进行了调查。在干预组，接受PC会诊的患者未经调整的比例从2.7%增至5.2%。与对照组相比，随着时间推移并对多个协变量进行调整后，干预措施增加了PC会诊（差异中的差异[DID]=增加1.0个百分点[95%置信区间=0.3%-1.8%]），并缩短了非癌症诊断入院患者的会诊时间（DID=-5天[95%置信区间=-11至-1]）。住院医师认为该干预措施有助于实现有效的患者护理，且未增加负担。
