Division of Hospital Medicine, Department of Internal Medicine, National Taiwan Uinversity Hospital, Taipei, Taiwan.
Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
BMJ Open. 2019 Feb 19;9(2):e021561. doi: 10.1136/bmjopen-2018-021561.
Shared decision making is essential for patients and their families when facing serious and life-threatening diseases. This study aimed to evaluate the impact of patient-centred and family-centred care meetings (PFCCM) on intensive measures and resource utilisation during end-of-life (EOL) hospitalisation among terminally ill patients.
A retrospective cross-sectional study using electronic medical records was conducted in a tertiary referral medical centre in Taiwan.
We identified 6843 deceased patients with terminal illness who either received or did not receive PFCCM during EOL hospitalisation between January 2013 and December 2015.
Patients who were transferred to the intensive care unit (ICU). Those who underwent invasive or non-invasive mechanical ventilation, tracheostomy, haemodialysis and surgical intervention during the final hospitalisation were determined by the use of intensive care measures; secondary measures were individual total and daily medical expenditures. A generalised estimating equation (GEE) model was used to compare the differences between the two groups. OR and beta coefficients (β) with 95% CI were estimated.
This study identified 459 patients (6.7%) who received PFCCM during EOL hospitalisation. Multivariate analyses showed that patients who received PFCCM were less likely to have ICU admissions (OR 0.44, 95% CI 0.34 to 0.57), undergo surgical interventions (OR 0.74, 95% CI 0.58 to 0.95) and invasive mechanical ventilation (OR 0.50, 95% CI 0.38 to 0.66) during the final hospitalisation, after adjusting for patient demographics, clinical conditions and year of admission. Additionally, a significant decrease in daily medical expenditures was observed in PFCCM patients (β -0.18, 95% CI -0.25 to -0.12) than in non-PFCCM patients.
Patient-physician discussion through PFCCM is associated with less intensive care utilisation and daily medical expenditure during EOL hospitalisation in terminally ill patients.
在面临严重危及生命的疾病时，共享决策对于患者及其家属至关重要。本研究旨在评估以患者为中心和以家庭为中心的护理会议（PFCCM）对终末期患者住院期间强化措施和资源利用的影响。
这是一项在台湾一家三级转诊医疗中心使用电子病历进行的回顾性横断面研究。
我们确定了 2013 年 1 月至 2015 年 12 月期间在终末期住院期间接受或未接受 PFCCM 的 6843 名患有终末期疾病的已故患者。
患者转至重症监护病房（ICU）。通过使用重症监护措施确定了在最后一次住院期间接受侵入性或非侵入性机械通气、气管切开术、血液透析和手术干预的患者；次要措施为个人总医疗支出和每日医疗支出。使用广义估计方程（GEE）模型比较两组之间的差异。估计 OR 和β系数（β）及其 95%CI。
本研究确定了 459 名（6.7%）在终末期住院期间接受 PFCCM 的患者。多变量分析显示，接受 PFCCM 的患者入住 ICU 的可能性较低（OR 0.44，95%CI 0.34 至 0.57），接受手术干预（OR 0.74，95%CI 0.58 至 0.95）和侵入性机械通气（OR 0.50，95%CI 0.38 至 0.66）的可能性较低，调整患者人口统计学、临床状况和入院年份后。此外，与非 PFCCM 患者相比，PFCCM 患者的每日医疗支出显著减少（β-0.18，95%CI-0.25 至-0.12）。
通过 PFCCM 进行医患讨论与终末期患者住院期间强化护理的使用和每日医疗支出减少相关。
