Kadu Mudathira, Mondor Luke, Hsu Amy, Webber Colleen, Howard Michelle, Tanuseputro Peter
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Palliat Med Rep. 2021 Feb 1;2(1):25-33. doi: 10.1089/pmr.2020.0095. eCollection 2021.
Evidence of the impact of inpatient palliative care on receiving home-based palliative care remains limited. The objective of this study was to examine, at a population level, the association between receiving inpatient palliative care and home-based palliative care postdischarge. We conducted a retrospective cohort study to examine the association between receiving inpatient palliative care and home-based palliative care within 21 days of hospital discharge among decedents in the last six months of life. We captured all decedents who were discharged alive from an acute care hospital in their last 180 days of life between April 1, 2014, and March 31, 2017, in Ontario, Canada. The index event was the first hospital discharge furthest away from death (i.e., closest to 180 days before death). Decedents who had inpatient palliative care were significantly more likely to receive home-based palliative care after discharge (80.0% vs. 20.1%; < 0.001). After adjusting for sociodemographic and clinical covariates, the odds of receiving home-based palliative care were 11.3 times higher for those with inpatient palliative care (95% confidence interval [CI]: 9.4-13.5; < 0.001). The strength of the association incrementally decreased as death approached. The odds of receiving home-based palliative care after a hospital discharge 60 days before death were 7.7 times greater for those who received inpatient palliative care (95% CI: 6.0-9.8). Inpatient palliative care offers a distinct opportunity to improve transitional care between hospital and home, through enhancing access to home-based palliative care.
住院姑息治疗对接受居家姑息治疗影响的证据仍然有限。本研究的目的是在人群层面上研究接受住院姑息治疗与出院后居家姑息治疗之间的关联。我们进行了一项回顾性队列研究，以检验在生命最后六个月的死者中，接受住院姑息治疗与出院后21天内接受居家姑息治疗之间的关联。我们纳入了2014年4月1日至2017年3月31日在加拿大安大略省于生命最后180天内从急症医院存活出院的所有死者。索引事件是距离死亡最远（即最接近死亡前180天）的首次出院。接受住院姑息治疗的死者出院后接受居家姑息治疗的可能性显著更高（80.0%对20.1%；P<0.001）。在调整了社会人口统计学和临床协变量后，接受住院姑息治疗者接受居家姑息治疗的几率高出11.3倍（95%置信区间[CI]：9.4-13.5；P<0.001）。随着死亡临近，这种关联的强度逐渐降低。在死亡前60天出院后接受居家姑息治疗的几率，接受住院姑息治疗者比未接受者高7.7倍（95%CI：6.0-9.8）。住院姑息治疗提供了一个独特的机会，通过增加获得居家姑息治疗的机会来改善医院与家庭之间的过渡性照护。
