1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.
Otolaryngol Head Neck Surg. 2019 Sep;161(3):439-441. doi: 10.1177/0194599819846072. Epub 2019 Apr 23.
The Quality Oncology Practice Initiative has several metrics related to end-of life (EOL) care, including hospice enrollment ≤3 days, with lower scores signaling better performance. Of privately insured patients with head and neck cancer, 3.5% were enrolled in hospice prior to death and 21.3% spent ≤3 days in hospice, indicating aggressive EOL care. Patients with late hospice enrollment had higher spending in the last 30 days of life (DOL). Patients in hospice ≤3 days spent $37,426, while those in hospice >3 days spent $24,418 ( = .002). The largest portion of this difference was attributable to inpatient services. Patients in hospice ≤3 days spent $22,089 on inpatient services in the last 30 DOL, while those in hospice >3 days spent $8361 ( < .001). Further research is needed to determine if more high-value care can be provided with earlier hospice enrollment and to ensure that goal concordance is included in defining high-value care.
质量肿瘤实践倡议（Quality Oncology Practice Initiative）有几个与临终关怀相关的指标，包括临终关怀入院≤3 天，分数越低表示表现越好。在私人保险的头颈部癌症患者中，有 3.5%在死前入临终关怀，有 21.3%在临终关怀中≤3 天，表明临终关怀积极。临终关怀入院较晚的患者在生命的最后 30 天（DOL）的花费更高。临终关怀≤3 天的患者在最后 30 天 DOL 的住院费用为 37426 美元，而临终关怀>3 天的患者为 24418 美元（=0.002）。造成这种差异的最大部分归因于住院服务。临终关怀≤3 天的患者在生命的最后 30 天 DOL 中花费 22089 美元用于住院服务，而临终关怀>3 天的患者花费 8361 美元（<0.001）。需要进一步研究以确定是否可以通过更早地入临终关怀来提供更多高价值的护理，并确保目标一致性包括在定义高价值护理中。
