Department of Medicine, University of Toronto.
ICES.
Med Care. 2021 Jul 1;59(7):604-611. doi: 10.1097/MLR.0000000000001524.
Patients who receive palliative care are less likely to die in hospital.
To measure the association between physician rates of referral to palliative care and location of death in hospitalized adults with serious illness.
Population-based decedent cohort study using linked health administrative data in Ontario, Canada.
A total of 7866 physicians paired with 130,862 hospitalized adults in their last year of life who died of serious illness between 2010 and 2016.
Physician annual rate of referral to palliative care (high, average, low).
Odds of death in hospital versus home, adjusted for patient characteristics.
There was nearly 4-fold variation in the proportion of patients receiving palliative care during follow-up based on attending physician referral rates: high 42.4% (n=24,433), average 24.7% (n=10,772), low 10.7% (n=6721). Referral to palliative care was also associated with being referred by palliative care specialists and in urban teaching hospitals. The proportion of patients who died in hospital according to physician referral rate were 47.7% (high), 50.1% (average), and 52.8% (low). Hospitalized patients cared for by a physician who referred to palliative care at a high rate had lower risk of dying in hospital than at home compared with patients who were referred by a physician with an average rate of referral [adjusted odds ratio 0.91; 95% confidence interval, 0.86-0.95; number needed to treat=57 (interquartile range 41-92)] and by a physician with a low rate of referral [adjusted odds ratio 0.81; 95% confidence interval, 0.77-0.84; number needed to treat =28 patients (interquartile range 23-44)].
An attending physicians' rates of referral to palliative care is associated with a lower risk of dying in hospital. Therefore, patients who are cared for by physicians with higher rates of referral to palliative care are less likely to die in hospital and more likely to die at home. Standardizing referral to palliative care may help reduce physician-level variation as a barrier to access.
接受姑息治疗的患者在医院死亡的可能性较低。
测量在安大略省接受姑息治疗的医生比例与住院重病患者死亡地点之间的关联。
使用加拿大安大略省的链接健康管理数据进行基于人群的死亡队列研究。
共 7866 名医生与 130862 名在生命的最后一年死于 2010 年至 2016 年期间的严重疾病的住院成年人配对，这些成年人在住院期间死亡。
医生每年接受姑息治疗的转诊率（高、中、低）。
调整患者特征后，在医院死亡与在家死亡的几率。
根据主治医生的转诊率，在随访期间接受姑息治疗的患者比例差异近 4 倍：高 42.4%（n=24433），中 24.7%（n=10772），低 10.7%（n=6721）。姑息治疗的转诊也与姑息治疗专家和城市教学医院的转诊有关。根据医生转诊率，在医院死亡的患者比例分别为 47.7%（高）、50.1%（中）和 52.8%（低）。与由转诊率中等的医生治疗的患者相比，由高转诊率的医生治疗的住院患者在医院死亡的风险较低，而由低转诊率的医生治疗的患者在医院死亡的风险较高[调整后的优势比为 0.91；95%置信区间为 0.86-0.95；需要治疗的人数为 57 人（四分位距 41-92）]和由低转诊率的医生治疗的患者[调整后的优势比为 0.81；95%置信区间为 0.77-0.84；需要治疗的人数为 28 人（四分位距 23-44）]。
主治医生的姑息治疗转诊率与在医院死亡的风险降低有关。因此，由转诊率较高的医生治疗的患者在医院死亡的可能性较低，在家死亡的可能性较高。姑息治疗的转诊标准化可能有助于减少医生水平的差异，从而减少获得姑息治疗的障碍。
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