Rogers Maggie M, Meier Diane E, Morrison R Sean, Moreno Jaison, Aldridge Melissa
Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Palliat Med. 2021 May;24(5):712-718. doi: 10.1089/jpm.2020.0282. Epub 2020 Oct 15.
In the United States, the percentage of hospitals over 50 beds with palliative care programs has risen substantially from 7% of hospitals in 2001 to 72% in 2017. Yet the dynamic nature of program adoption and closure over time is not known. To examine the rate of palliative care program adoption and closure and associated hospital and geographic characteristics in a national sample of U.S. hospitals. Adoption and closure rates were calculated for 3696 U.S. hospitals between 2009 and 2017. We used multivariable logistic regression models to examine the association between adoption and closure status and hospital, geographic, and community characteristics. All nonfederal general medical and surgical, cancer, heart, and obstetric or gynecological hospitals, of all sizes, in the United States in operation in both 2009 and 2017. By 2017, 34.9% (812/2327) of the hospitals without palliative care in 2009 had adopted palliative care programs, and 15.0% (205/1369) of the hospitals with programs had closed them. In multivariable models, hospitals in metropolitan areas, nonprofit and public hospitals (compared to for-profit hospitals), and those with residency training approval by the Accreditation Council for Graduate Medical Education were significantly more likely to adopt and significantly less likely to close palliative care programs during the study period. This study indicates that palliative care is not equitably adopted nor sustained by hospitals in the United States. Federal and state interventions may be required to ensure that high-quality care is available to our nation's sickest patients.
在美国，拥有姑息治疗项目的50张床位以上医院的比例已大幅上升，从2001年的7%升至2017年的72%。然而，随着时间推移，项目采用和关闭的动态情况尚不清楚。为了在美国医院的全国样本中研究姑息治疗项目的采用率和关闭率以及相关的医院和地理特征。计算了2009年至2017年期间3696家美国医院的采用率和关闭率。我们使用多变量逻辑回归模型来研究采用和关闭状态与医院、地理和社区特征之间的关联。研究对象为2009年和2017年运营的美国所有规模的非联邦综合内科和外科、癌症、心脏以及产科或妇科医院。到2017年，2009年没有姑息治疗项目的医院中有34.9%（812/2327）采用了该项目，而有项目的医院中有15.0%（205/1369）关闭了项目。在多变量模型中，大都市地区的医院、非营利性和公立医院（与营利性医院相比）以及那些获得研究生医学教育认证委员会住院医师培训批准的医院在研究期间更有可能采用且更不太可能关闭姑息治疗项目。这项研究表明，美国医院在采用和维持姑息治疗方面并不公平。可能需要联邦和州的干预措施，以确保为我国病情最严重的患者提供高质量的护理。
