Mracek Jennifer, Earp Madalene, Sinnarajah Aynharan
University of Calgary, Calgary, Alberta, Canada.
Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
BMJ Support Palliat Care. 2024 Dec 19;14(e3):e2632-e2641. doi: 10.1136/bmjspcare-2021-002889.
Evaluate the association of specialist palliative home care (HC) on emergency department (ED) visits in the 30 and 90 days prior to death.
This retrospective cohort study using administrative data identified 6976 adults deceased from cancer between 2008 and 2015, living ≥180 days after diagnosis of cancer, and residing in the urban Calgary Zone of Alberta Health Services. All palliative HC and generalist HC services were examined. Regression analyses examined the relationships of HC type to ED visits in the last 30 or 90 days of life.
In the last 30 days of life, compared with patients receiving palliative HC, patients receiving only generalist HC, or no HC, were more likely to visit the ED (OR) 1.19; 95% CI 1.06 to 1.34; OR 1.54; 95% CI 1.31 to 1.82). In the last 90 days of life, compared with patients receiving palliative HC, those receiving generalist HC (OR 1.48; 95% CI 1.32 to 1.67) and no HC (OR 1.66; 95% CI 1.39 to 1.99) had increased odds of visiting the ED.
Receiving generalist HC and no HC was associated with increased odds of visiting the ED in the last 30 and 90 days of life, when compared with patients receiving palliative HC. Improving access to palliative HC for patients at high risk of visiting the ED may reduce ED visits and acute care costs and improve quality of life in the last 90 days of life.
评估专科姑息居家护理（HC）与死亡前30天和90天内急诊就诊之间的关联。
这项回顾性队列研究使用行政数据，确定了2008年至2015年间6976名死于癌症的成年人，他们在癌症诊断后存活≥180天，居住在艾伯塔省卫生服务局卡尔加里市区。对所有姑息性HC和全科HC服务进行了检查。回归分析研究了HC类型与生命最后30天或90天内急诊就诊之间的关系。
在生命的最后30天，与接受姑息性HC的患者相比，仅接受全科HC或未接受HC的患者更有可能去急诊就诊（比值比[OR]1.19；95%置信区间[CI]1.06至1.34；OR 1.54；95%CI 1.31至1.82）。在生命的最后90天，与接受姑息性HC的患者相比，接受全科HC的患者（OR 1.48；95%CI 1.32至1.67）和未接受HC的患者（OR 1.66；95%CI 1.39至1.99）去急诊就诊的几率增加。
与接受姑息性HC的患者相比，接受全科HC以及未接受HC与生命最后30天和90天内急诊就诊几率增加有关。改善有急诊就诊高风险患者获得姑息性HC的机会，可能会减少急诊就诊和急性护理费用，并改善生命最后90天的生活质量。
