Berglund Keisha, Chai Emily, Moreno Jaison, Reyna Maria, Gelfman Laura P
Department of Social Work Services, Mount Sinai Medical Center, New York, New York, USA.
Brookdale Department of Geriatrics and Palliative Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Palliat Med Rep. 2020 Oct 22;1(1):234-241. doi: 10.1089/pmr.2020.0093. eCollection 2020.
To increase earlier access to palliative care, and in turn increase documented goals of care and appropriate hospice referrals for seriously ill patients admitted to hospital medicine. Due to the growing number of patients with serious illness and the specialty palliative care workforce shortage, innovative primary palliative care models are essential to meet this population's needs. Patients with serious illness admitted to hospital medicine at a quaternary urban academic medical center in New York City and received an embedded palliative care social worker consultation in 2017. We used univariate analyses of sociodemographic, clinical, and utilization data to describe the sample. Overall, 232 patients received a primary palliative care consultation (mean age of 69 years, 44.8% female, 34% white, median Karnofsky Performance Status of 40%), and 159 (69%) had capacity to participate in a goals-of -are conversation. Referrals were from palliative care solid tumor oncology trigger program (113 [49%]), specialty palliative care consultation team (42[18%]), and hospital medicine (34[14.6%]). Before the consultation, 10(4.3%) had documented goals of care and 207 (89%) did after the consultation. The percentage of those referred to hospice was 24.1%. Of those transferred to specialty palliative care consultation service, nearly half required symptom management. Patients who received a primary palliative care consultation were seen earlier in their illness trajectory, based on their higher functional impairment, and the majority had capacity to participate in goals-of-care discussions, compared with those who were seen by specialty palliative care. The consultation increased goals-of-care documentation and the hospice referral rate was comparable with that of the specialty palliative consultation team.
为了更早地提供姑息治疗，并相应增加对入住医院内科的重症患者记录在案的护理目标和适当的临终关怀转诊。由于重症患者数量不断增加以及专科姑息治疗劳动力短缺，创新的初级姑息治疗模式对于满足这一人群的需求至关重要。2017年，在纽约市一家四级城市学术医疗中心入住医院内科的重症患者接受了嵌入式姑息治疗社会工作者的咨询。我们使用社会人口统计学、临床和利用数据的单变量分析来描述样本。总体而言，232名患者接受了初级姑息治疗咨询（平均年龄69岁，44.8%为女性，34%为白人，卡氏功能状态中位数为40%），159名（69%）有能力参与护理目标对话。转诊来自姑息治疗实体肿瘤触发项目（113例[49%]）、专科姑息治疗咨询团队（42例[18%]）和医院内科（34例[14.6%]）。咨询前，10名（4.3%）有记录在案的护理目标，咨询后有207名（89%）有记录。转诊至临终关怀的比例为24.1%。在转至专科姑息治疗咨询服务的患者中，近一半需要症状管理。与接受专科姑息治疗的患者相比，接受初级姑息治疗咨询的患者在疾病轨迹中更早接受诊治，因为他们功能障碍更高，且大多数有能力参与护理目标讨论。咨询增加了护理目标记录，临终关怀转诊率与专科姑息治疗咨询团队相当。
