Department of Health Research, SINTEF Digital, P.O. Box 4760, Sluppen, NO-7465, Trondheim, Norway.
BMC Health Serv Res. 2020 May 24;20(1):454. doi: 10.1186/s12913-020-05283-6.
While the majority of deaths in high-income countries currently occur within institutional settings such as hospitals and nursing homes, there is considerable variation in the pattern of place of death. The place of death is known to impact many relevant considerations about death and dying, such as the quality of the dying process, family involvement in care, health services design and health policy, as well as public versus private costs of end-of-life care. The objective of this study was to analyse how the availability and capacity of publicly financed home-based and institutional care resources are related to place of death in Norway.
This study utilized a dataset covering all deaths in Norway in the years 2003-2011, contrasting three places of death, namely hospital, nursing home and home. The analysis was performed using a multilevel multinomial logistic regression model to estimate the probability of each outcome while considering the hierarchical nature of factors affecting the place of death. The analysis utilized variation in health system variables at the local community and hospital district levels. The analysis was based on data from two public sources: the Norwegian Cause of Death Registry and Statistics Norway.
Hospital accessibility, in terms of short travel time and hospital bed capacity, was positively associated with the likelihood of hospital death. Higher capacity of nursing home beds increased the likelihood of nursing home death, and higher capacity of home care increased the likelihood of home death. Contrasting three alternative places of death uncovered a pattern of service interactions, wherein hospital and home care resources together served as an alternative to end-of-life care in nursing homes.
Norway has a low proportion of home deaths compared with other countries. The proportion of home deaths varies between local communities. Increasing the availability of home care services is likely to enable more people to die at home, if that is what they prefer.
虽然目前高收入国家的大多数死亡发生在医院和养老院等机构环境中，但死亡地点的模式存在相当大的差异。死亡地点已知会影响与死亡和临终相关的许多考虑因素，例如临终过程的质量、家庭对护理的参与、卫生服务设计和卫生政策，以及公共与私人临终护理成本。本研究的目的是分析在挪威，公共资助的家庭和机构护理资源的可用性和能力与死亡地点的关系。
本研究使用了一个涵盖 2003-2011 年挪威所有死亡的数据集，对比了三个死亡地点，即医院、养老院和家庭。分析使用了多层次多项逻辑回归模型，在考虑影响死亡地点的因素的层次性质的同时，估计每种结果的概率。分析利用了社区和医院区一级卫生系统变量的差异。分析基于来自两个公共来源的数据：挪威死因登记处和挪威统计局。
以短旅行时间和医院床位容量衡量的医院可及性与医院死亡的可能性呈正相关。养老院床位容量增加增加了养老院死亡的可能性，家庭护理床位容量增加增加了家庭死亡的可能性。对比三个替代的死亡地点揭示了服务相互作用的模式，其中医院和家庭护理资源共同作为养老院临终护理的替代选择。
与其他国家相比，挪威的家庭死亡比例较低。家庭死亡的比例在不同的社区之间有所不同。增加家庭护理服务的可及性可能会使更多人选择在家中死亡，如果这是他们所希望的。
