Florian B. Mayr is a staff physician, Critical Care Service Line, VA Pittsburgh Healthcare System, and an assistant professor, Clinical Research, Investigation, and Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Judith L. Plowman is a staff physician, Community Based Care Service Line, VA Pittsburgh Healthcare System.
Am J Crit Care. 2021 Jan 1;30(1):e12-e31. doi: 10.4037/ajcc2021117.
Elderly patients frequently experience deteriorating health after critical illness, which may threaten their independence and predispose them to unplanned hospital readmissions and premature death.
To evaluate the operational feasibility of a 90-day home-based palliative care intervention in multimorbid elderly Veteran survivors of critical illness.
A multidisciplinary home-based palliative care intervention was provided for multimorbid elderly veterans who were discharged home after admission to the intensive care unit for sepsis, pneumonia, heart failure, or exacerbation of chronic obstructive lung disease.
Fifteen patients enrolled in the study, 11 (73%) of whom completed all visits; thus the prespecified goal of >70% completion was met. Median (interquartile range [IQR]) age of the patients was 76 (69-87) years. Participants had a median (IQR) of 8 (7-8) concurrent chronic health conditions, were moderately debilitated at baseline, and were all male. The median (IQR) time to the first study visit was 8 (5-12) days. Patients had a median (IQR) of 8 (5-11) in-home visits and 6 (3-7) telephone encounters during the 90-day study period. Nurses spent a median (IQR) cumulative time of 330 (240-585) minutes on home visits and 30 (10-70) minutes on telephone visits. The median (IQR) time per home provider visit was 90 (75-90) minutes. We estimated the median (IQR) cost per patient to be $2321 ($1901-$3331).
A comprehensive home-based palliative care intervention is operationally feasible in elderly multi-morbid survivors of critical illness and may result in improved physical functioning and quality of life and fewer unplanned emergency department visits.
老年患者在经历重病后常常健康状况恶化，这可能威胁到他们的独立性，并使他们更容易出现计划外的医院再入院和过早死亡。
评估针对患有多种合并症的重症后老年退伍军人的 90 天家庭为基础的姑息治疗干预措施的操作可行性。
为因败血症、肺炎、心力衰竭或慢性阻塞性肺疾病恶化而入住重症监护病房后出院回家的患有多种合并症的老年退伍军人提供多学科的家庭为基础的姑息治疗干预措施。
本研究纳入了 15 名患者，其中 11 名（73%）完成了所有访视；因此，达到了 >70%完成率的预设目标。患者的中位（四分位距 [IQR]）年龄为 76（69-87）岁。参与者有 8（7-8）种并存的慢性健康状况，基线时中度虚弱，均为男性。首次研究访视的中位（IQR）时间为 8（5-12）天。患者在 90 天研究期间接受了中位（IQR）8（5-11）次家庭访视和 6（3-7）次电话访视。护士在家庭访视中花费的中位（IQR）累计时间为 330（240-585）分钟，在电话访视中花费 30（10-70）分钟。每位家庭提供者访视的中位（IQR）时间为 90（75-90）分钟。我们估计每位患者的中位（IQR）成本为 2321 美元（1901-3331 美元）。
针对患有多种合并症的重症后老年幸存者的综合家庭为基础的姑息治疗干预措施在操作上是可行的，可能会改善身体功能和生活质量，并减少计划外急诊就诊次数。
