College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11221, Taiwan.
Department of Medicine, School of Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, Taipei 24205, Taiwan.
Int J Environ Res Public Health. 2019 Nov 20;16(23):4609. doi: 10.3390/ijerph16234609.
To explore the influence of hospital and patient characteristics on deaths at home among inpatients facing impending death. In this historical cohort study, 95,626 inpatients facing impending death from 362 hospitals in 2011 were recruited. The dependent variable was the place of death. The independent variables were the characteristics of the hospitals and the patients. A two-level hierarchical generalized linear model was used. In total, 41.06% of subjects died at home. The hospital characteristics contributed to 29.25% of the total variation of the place of death. Private hospitals (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.00-1.75), patients >65 years old (OR = 1.48, 95% CI. = 1.42-1.54), married (OR = 3.15, 95% CI. = 2.93-3.40) or widowed (OR = 3.39, 95% CI. = 3.12-3.67), from near-poor households (OR = 5.16, 95% CI. = 4.57-5.84), having diabetes mellitus (OR = 1.79, 95% CI. = 1.65-1.94), and living in a subcounty (OR = 2.27, 95% CI. = 2.16-2.38) were all risk factors for a death at home. Both hospital and patient characteristics have an effect of deaths at home among inpatients facing impending death. The value of the inpatient mortality rate as a major index of hospital accreditation should be interpreted intrinsically with the rate of deaths at home.
探讨在面临死亡的住院患者中，医院和患者特征对在家中死亡的影响。在这项回顾性队列研究中，招募了 2011 年来自 362 家医院的 95626 名面临死亡的住院患者。因变量为死亡地点。自变量为医院和患者的特征。采用两水平层次广义线性模型。共有 41.06%的患者在家中死亡。医院特征对死亡地点的总变异有 29.25%的贡献。私立医院（比值比 [OR] = 1.32，95%置信区间 [CI] = 1.00-1.75）、年龄 >65 岁的患者（OR = 1.48，95% CI = 1.42-1.54）、已婚（OR = 3.15，95% CI = 2.93-3.40）或丧偶（OR = 3.39，95% CI = 3.12-3.67）、来自贫困家庭（OR = 5.16，95% CI = 4.57-5.84）、患有糖尿病（OR = 1.79，95% CI = 1.65-1.94）和居住在乡镇以下地区（OR = 2.27，95% CI = 2.16-2.38）的患者，均是在家中死亡的危险因素。医院和患者特征都对面临死亡的住院患者的在家中死亡有影响。住院患者死亡率作为医院认证的主要指标的价值，应该与在家中死亡的比例一起进行内在地解释。
