Rush Barret, Fruhstofer Clark, Walley Keith R, Celi Leo Anthony, Brahmania Mayur
Division of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Department of Medicine, University of British Columbia, Vancouver, Canada.
BMJ Support Palliat Care. 2019 Feb 13. doi: 10.1136/bmjspcare-2018-001635.
Patients with end-stage liver disease (ESLD) have a reduced life expectancy and a significant symptom burden. Our aim is to determine if inpatient palliative care (PC) referral for patients with ESLD is associated with decreased hospital readmission rates.
The 2013 US Nationwide Readmission Database (NRD) was used for the current analysis. The NRD allows for longitudinal analysis of all patient hospital admissions across 22 states. Patients ≥18 years of age with a diagnosis of ESLD with at least two decompensating events were included in the analysis. PC referral at the index hospitalisation divided the cohort into two groups, which were tracked for 9 months.
A total of 14 325 172 hospital admissions from the 2013 NRD were examined. In the first 3 months of 2013, a total of 3647 patients with ESLD were admitted with 206 (5.6%) receiving PC referral during the index admission. After the index hospitalisation, patients referred to PC were more likely to be discharged to skilled nursing facilities (45.5% vs 14.7%; p<0.01) or hospice/home care (32.9% vs 15.3%; p<0.01). After propensity score matching, those patients referred to PC demonstrated a significantly lower rate of 1-year hospital readmission (11.0% vs 32.1%; p<0.01).
Inpatient PC referral for patients with ESLD was associated with lower rates of hospital readmission. Early concurrent PC referral likely has added beneficial effects beyond quality of life issues and symptom management.
终末期肝病（ESLD）患者预期寿命缩短，症状负担沉重。我们的目的是确定ESLD患者住院姑息治疗（PC）转诊是否与降低医院再入院率相关。
本次分析使用了2013年美国全国再入院数据库（NRD）。NRD允许对22个州所有患者的住院情况进行纵向分析。分析纳入了年龄≥18岁、诊断为ESLD且至少有两次失代偿事件的患者。在首次住院时进行PC转诊将队列分为两组，并对其进行9个月的跟踪。
共检查了2013年NRD中的14325172例住院病例。在2013年的前3个月，共有3647例ESLD患者入院，其中206例（5.6%）在首次住院期间接受了PC转诊。首次住院后，转诊至PC的患者更有可能被转至专业护理机构（45.5%对14.7%；p<0.01）或临终关怀/家庭护理机构（32.9%对15.3%；p<0.01）。倾向评分匹配后，转诊至PC的患者1年再入院率显著较低（11.0%对32.1%；p<0.01）。
ESLD患者住院PC转诊与较低的医院再入院率相关。早期同时进行PC转诊可能除了对生活质量问题和症状管理外还有额外的有益效果。
