Assareh Hassan, Stubbs Joanne M, Trinh Lieu T T, Greenaway Sally, Agar Meera, Achat Helen M
Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, New South Wales, Australia
Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, New South Wales, Australia.
BMJ Support Palliat Care. 2020 Sep;10(3):e27. doi: 10.1136/bmjspcare-2018-001578. Epub 2018 Nov 8.
Use of palliative care in hospitals for people at end of life varies. We examined rate and time of in-hospital palliative care use and associated interhospital variations.
We used admissions from all hospitals in New South Wales, Australia, within a 12-month period, for a cohort of adults who died in 73 public acute care hospitals between July 2010 and June 2014. Receiving palliative care and its timing were based on recorded use.
Among 90 696 adults who died, 27% received palliative care, and the care was initiated 7.6 days (mean; SD: 3.3 days) before death. Over the 5-year period, the palliative care rate rose by 58%, varying extent across chronic conditions. The duration of palliative care before death declined by 7%. Patient (demographics, morbidities and service use) and hospital factors (size, location and availability of palliative care unit) explained half of the interhospital variation in outcomes: adjusted IQR in rate and duration of palliative care among hospitals were 23%-39% and 5.2-8.7 days, respectively. Hospitals with higher rates often initiated palliative care earlier (correlation: 0.39; p<0.01).
Despite an increase over time in the palliative care rate, its initiation was late and of brief duration. Palliative care use was associated with patient and hospital characteristics; however, half of the between hospital variation remained unexplained. The observed suboptimal practices and variability indicate the need for expanded and standardised use of palliative care supported by assessment tools, service enhancement and protocols.
医院对临终患者姑息治疗的使用情况各不相同。我们研究了住院姑息治疗的使用率、使用时间以及医院间的差异。
我们利用了澳大利亚新南威尔士州所有医院在12个月内的数据，这些数据来自2010年7月至2014年6月期间在73家公立急症医院死亡的成年患者队列。接受姑息治疗及其时间基于记录的使用情况。
在90696名死亡的成年人中，27%接受了姑息治疗，且在死亡前7.6天（均值；标准差：3.3天）开始接受治疗。在这5年期间，姑息治疗率上升了58%，不同慢性病的上升幅度有所不同。死亡前姑息治疗的持续时间下降了7%。患者因素（人口统计学、发病率和服务使用情况）和医院因素（规模、位置和姑息治疗病房的可用性）解释了医院间结局差异的一半：医院姑息治疗率和持续时间的调整后四分位距分别为23%-39%和5.2-8.7天。姑息治疗率较高的医院往往更早开始提供姑息治疗（相关性：0.39；p<0.01）。
尽管姑息治疗率随时间有所上升，但其开始时间较晚且持续时间较短。姑息治疗的使用与患者和医院特征有关；然而，医院间差异的一半仍无法解释。观察到的不规范做法和变异性表明，需要借助评估工具、服务改进和方案来扩大和规范姑息治疗的使用。
