RAND Corporation, Arlington, Virginia, USA.
RAND Corporation, Santa Monica, California, USA.
J Palliat Med. 2020 Dec;23(12):1639-1643. doi: 10.1089/jpm.2019.0505. Epub 2020 Mar 6.
The hospice market has changed substantially, shifting from predominately not-for-profit independent entities to for-profit national chains. Little is known about how hospice organizational characteristics are associated with quality of hospice care. To examine the association between hospice characteristics and care processes and performance on measures of hospice care quality. Logistic regression models assessed the association between hospice characteristics and processes and hospices being in the top quartile of quality measure performance. U.S. hospices with publicly reported measure scores in 2015-2017. Summaries of hospice-level performance on Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey measures (including communication, timely care, symptom management, emotional and spiritual support, respect, training families, overall rating, and willingness to recommend) and Hospice Item Set (HIS) measures (including pain screening and assessment, dyspnea screening and treatment, bowel regimen for patients on opioids, discussion of treatment preferences, and beliefs/values addressed). Of the 2746 hospices that met public reporting requirements, 5.6% were in the top quartile of both CAHPS and HIS performance. Characteristics associated with being in the top quartile for CAHPS included being a nonprofit and nonchain or government hospice, smaller size (<200 patients per year), and serving a rural area. Characteristics associated with being in the top quartile for HIS included being in a for-profit chain, larger size (91+ patients per year), and having <40% of patients in a nursing home. Providing professional staff visits in the last two days of life to a higher proportion of patients was associated with hospices being in the top quartile of HIS and in the top quartile of CAHPS. Hospice characteristics associated with strong performance on HIS measures differ from those associated with strong performance on CAHPS measures. Providing professional staff visits in the last two days of life is associated with high performance on both quality domains.
临终关怀市场发生了重大变化，从以非营利性独立实体为主转变为营利性全国连锁。关于临终关怀组织特征如何与临终关怀质量相关，人们知之甚少。本研究旨在探讨临终关怀特征与护理过程和绩效之间的关系，以及这些特征与衡量临终关怀质量的措施上的表现。采用逻辑回归模型评估了临终关怀特征与过程以及临终关怀机构在质量衡量指标表现的前四分之一之间的关联。纳入了 2015-2017 年有公开报告的测量得分的美国临终关怀机构。对患者对医疗保健提供者和系统的评估（CAHPS）临终关怀调查措施（包括沟通、及时护理、症状管理、情感和精神支持、尊重、培训家属、总体评分和推荐意愿）和临终关怀项目集（HIS）措施（包括疼痛筛查和评估、呼吸困难筛查和治疗、阿片类药物患者的肠道方案、治疗偏好讨论和解决信仰/价值观）的 Hospice 层面绩效进行总结。在符合公开报告要求的 2746 家临终关怀机构中，有 5.6%的机构在 CAHPS 和 HIS 绩效的前四分之一。与 CAHPS 表现前四分之一相关的特征包括非营利性和非连锁或政府经营的临终关怀机构、规模较小（每年<200 名患者）和服务于农村地区。与 HIS 表现前四分之一相关的特征包括营利性连锁、规模较大（每年 91 名以上患者）和<40%的患者在养老院。在生命的最后两天为更高比例的患者提供专业人员探访与 hospices 在 HIS 和 CAHPS 的前四分之一相关。与 HIS 措施表现出色相关的临终关怀特征与与 CAHPS 措施表现出色相关的特征不同。在生命的最后两天为患者提供专业人员探访与两个质量领域的出色表现相关。
