Stanford Section of Palliative Medicine, Division of Primary Care and Population Health, Department of Medicine, Stanford School of Medicine, Palo Alto, California, USA.
Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
J Pain Symptom Manage. 2021 Jul;62(1):28-38. doi: 10.1016/j.jpainsymman.2020.11.020. Epub 2020 Nov 25.
Understanding the unique needs of patients seen in clinic versus at home can help palliative care (PC) teams choose how to maximize available resources.
To compare the characteristics and PC needs of patients seen by PC teams in clinic versus at home.
We analyzed data from the Palliative Care Quality Network between August 2016 and September 2019 and compared demographics, diagnosis, reason for referral, PC needs, functional status, self-reported symptoms, and patient-reported quality of life.
Compared to patients receiving PC in clinic, patients receiving PC at home were more likely to be of age 80 years or older (odds ratio [OR] 7.5, 95% CI 5.0, 10.9, P < 0.0001), have lower functional status (mean Palliative Performance Scale score 53% vs. 68%, P < 0.0001), and were less likely to screen positive for needing pain management (OR 0.31, 95% CI 0.22, 0.42, P < 0.0001) or other symptom management (OR 0.61, 95% CI 0.41, 0.90, P = 0.01). Patients receiving care at home were more likely to be referred for care planning (goals of care discussions or advance care planning) (OR 11.5, 95% CI 8.3, 16.0 P < 0.0001) and patient/family support (OR 5.9, 95% CI 4.2, 8.3, P < 0.0001).
Patients seen by PC teams at home had worse function and were more likely to be referred for care planning, while patients seen in clinic had more PC needs related to pain and symptom management. Despite these differences, both populations have significant PC needs that support routine assessment and require appropriately staffed interdisciplinary teams to address these needs.
了解在诊所和家中接受姑息治疗（PC）的患者的独特需求，可以帮助 PC 团队选择如何最大限度地利用现有资源。
比较在诊所和家中接受 PC 团队治疗的患者的特征和 PC 需求。
我们分析了 2016 年 8 月至 2019 年 9 月期间姑息治疗质量网络的数据，并比较了人口统计学特征、诊断、转诊原因、PC 需求、功能状态、自我报告的症状和患者报告的生活质量。
与在诊所接受 PC 的患者相比，在家中接受 PC 的患者更有可能年龄在 80 岁或以上（优势比 [OR] 7.5，95%置信区间 [CI] 5.0，10.9，P<0.0001），功能状态较低（平均姑息治疗表现量表评分 53%比 68%，P<0.0001），并且不太可能筛查出需要疼痛管理（OR 0.31，95%CI 0.22，0.42，P<0.0001）或其他症状管理（OR 0.61，95%CI 0.41，0.90，P=0.01）。在家中接受护理的患者更有可能接受护理计划（治疗目标讨论或预先护理计划）转诊（OR 11.5，95%CI 8.3，16.0，P<0.0001）和患者/家庭支持（OR 5.9，95%CI 4.2，8.3，P<0.0001）。
在家中接受 PC 团队治疗的患者功能更差，更有可能被转诊进行护理计划，而在诊所接受治疗的患者则更需要与疼痛和症状管理相关的 PC 需求。尽管存在这些差异，但这两个群体都有明显的 PC 需求，需要进行常规评估，并需要配备适当人员的跨学科团队来满足这些需求。
