Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Clinical Workforce Planning, Alberta Health Services, Calgary, Alberta, Canada.
BMJ Open. 2021 Mar 24;11(3):e044196. doi: 10.1136/bmjopen-2020-044196.
For eight chronic diseases, evaluate the association of specialist palliative care (PC) exposure and timing with hospital-based acute care in the last 30 days of life.
Retrospective cohort study using administrative data.
Alberta, Canada between 2007 and 2016.
47 169 adults deceased from: (1) cancer, (2) heart disease, (3) dementia, (4) stroke, (5) chronic lower respiratory disease (chronic obstructive pulmonary disease (COPD)), (6) liver disease, (7) neurodegenerative disease and (8) renovascular disease.
The proportion of decedents who experienced high hospital-based acute care in the last 30 days of life, indicated by ≥two emergency department (ED) visit, ≥two hospital admissions,≥14 days of hospitalisation, any intensive care unit (ICU) admission, or death in hospital. Relative risk (RR) and risk difference (RD) of hospital-based acute care given early specialist PC exposure (≥90 days before death), adjusted for patient characteristics.
In an analysis of all decedents, early specialist PC exposure was associated with a 32% reduction in risk of any hospital-based acute care as compared with those with no PC exposure (RR 0.69, 95% CI 0.66 to 0.71; RD 0.16, 95% CI 0.15 to 0.17). The association was strongest in cancer-specific analyses (RR 0.53, 95% CI 0.50 to 0.55; RD 0.31, 95% CI 0.29 to 0.33) and renal disease-specific analyses (RR 0.60, 95% CI 0.43 to 0.84; RD 0.22, 95% CI 0.11 to 0.34), but a~25% risk reduction was observed for each of heart disease, COPD, neurodegenerative diseases and stroke. Early specialist PC exposure was associated with reducing risk of four out of five individual indicators of high hospital-based acute care in the last 30 days of life, including ≥two ED visit,≥two hospital admission, any ICU admission and death in hospital.
Early specialist PC exposure reduced the risk of hospital-based acute care in the last 30 days of life for all chronic disease groups except dementia.
针对 8 种慢性病，评估专科姑息治疗（PC）的接触情况和时机与生命最后 30 天内的医院急性治疗之间的关联。
使用行政数据的回顾性队列研究。
加拿大阿尔伯塔省，2007 年至 2016 年。
47169 名成年人死于：（1）癌症，（2）心脏病，（3）痴呆症，（4）中风，（5）慢性下呼吸道疾病（慢性阻塞性肺疾病（COPD）），（6）肝脏疾病，（7）神经退行性疾病和（8）肾血管疾病。
生命最后 30 天内接受高医院急性治疗的死者比例，以≥2 次急诊就诊、≥2 次住院、≥14 天住院、任何重症监护病房（ICU）入院或医院死亡来表示。根据患者特征，调整专科 PC 早期接触（死亡前≥90 天）的医院急性治疗的相对风险（RR）和风险差异（RD）。
在对所有死者的分析中，与无 PC 暴露相比，专科 PC 早期暴露与任何医院急性治疗的风险降低 32%相关（RR 0.69，95%CI 0.66 至 0.71；RD 0.16，95%CI 0.15 至 0.17）。在癌症特异性分析中（RR 0.53，95%CI 0.50 至 0.55；RD 0.31，95%CI 0.29 至 0.33）和肾脏疾病特异性分析中（RR 0.60，95%CI 0.43 至 0.84；RD 0.22，95%CI 0.11 至 0.34），相关性最强，但心脏病、COPD、神经退行性疾病和中风的风险分别降低了~25%。专科 PC 早期暴露与生命最后 30 天内五种医院急性治疗的五种个体指标中的每一种都降低了风险，包括≥2 次急诊就诊、≥2 次住院、任何 ICU 入院和医院死亡。
除痴呆症外，专科 PC 早期暴露降低了所有慢性疾病组生命最后 30 天内的医院急性治疗风险。
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