Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, Seattle, Washington.
Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington.
J Am Geriatr Soc. 2018 Sep;66(9):1730-1736. doi: 10.1111/jgs.15455. Epub 2018 Jul 4.
To examine associations between healthcare transitions at the end of life (EOL; late transitions) and bereaved family members' and friends' assessment of EOL quality of care (QOC).
National Health and Aging Trends Study (NHATS), a prospective cohort of Medicare enrollees aged 65 and older.
United States, all sites of death.
Family members and close friends of decedents from NHATS Rounds 2 through 6 (N=1,653; weighted 6.0 million Medicare deaths).
Multivariable logistic regression with survey weights was used to examine the association between having a late transition and reports of perceived unmet needs for symptom management, spiritual support, concerns with communication, and overall QOC.
Seventeen percent of decedents had a late transition. Bereaved respondents for decedents experiencing late transitions were more likely to report that the decedent was treated without respect (21.3% vs 15.6%; adjusted odds ratio (AOR)=1.59, 95% confidence interval (CI)=1.09-2.33), had more unmet needs for spiritual support (67.4% v 55.2%; AOR=1.48, 95% CI=1.03-2.13), and were more likely to report they were not kept informed about the person's condition (31.0% vs 20.9%; AOR=1.54, 95% CI=1.07-2.23). Bereaved respondents were less likely to rate QOC as excellent when there was a late transition (43.6% vs 48.2%; AOR=0.79, 95% CI=0.58-1.06). Subgroup analyses of those experiencing a transition between a nursing home and hospital (13% of all late transitions) revealed such transitions to be associated with even worse QOC.
Transitions in the last 3 days of life are associated with more unmet needs, higher rate of concerns, and lower rating of QOC than when such late transitions are absent, especially when that transition is between a nursing home and hospital.
研究生命末期（晚期）医疗过渡与死者家属和朋友对临终关怀质量（QOC）评估之间的关联。
全国健康老龄化趋势研究（NHATS），一项针对 65 岁及以上医疗保险参保者的前瞻性队列研究。
美国，所有死亡地点。
来自 NHATS 第 2 至 6 轮的死者的家属和密友（N=1653；加权 600 万例医疗保险死亡）。
使用具有调查权重的多变量逻辑回归来检查晚期过渡与报告的症状管理、精神支持、沟通问题以及整体 QOC 方面未满足的需求之间的关联。
17%的死者经历了晚期过渡。与经历晚期过渡的死者的死者亲属更有可能报告说，死者受到不尊重的对待（21.3%比 15.6%；调整后的优势比（AOR）=1.59，95%置信区间（CI）=1.09-2.33），精神支持方面的需求更多未得到满足（67.4%比 55.2%；AOR=1.48，95% CI=1.03-2.13），并且更有可能报告说他们没有被告知关于该人的病情（31.0%比 20.9%；AOR=1.54，95% CI=1.07-2.23）。当发生晚期过渡时，死者亲属更不可能将 QOC 评为优秀（43.6%比 48.2%；AOR=0.79，95% CI=0.58-1.06）。对经历疗养院和医院之间过渡（所有晚期过渡的 13%）的亚组分析显示，这种过渡与更多的未满足需求、更高的担忧率以及更低的 QOC 评分相关，尤其是当这种过渡发生在疗养院和医院之间时。
与没有晚期过渡相比，生命最后 3 天的过渡与更多的未满足需求、更高的担忧率以及更低的 QOC 评分相关，尤其是当过渡发生在疗养院和医院之间时。
