Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SE5 9PJ, UK.
Int J Environ Res Public Health. 2021 Jul 7;18(14):7272. doi: 10.3390/ijerph18147272.
Evidence shows that community-based palliative home care (PHC) provision enhances continuous care and improves patient outcomes. This study compared patient survival, place of death, and medical utilization in community- versus hospital-based PHC. A retrospective cohort study was conducted of patients aged over 18 referred to either community- or hospital-based PHC from May to December 2018 at a tertiary hospital and surrounding communities in Southern Taiwan. A descriptive analysis, Chi-square test, -test, and Log-rank test were used for the data analysis of 131 hospital-based PHC patients and 43 community-based PHC patients, with 42 paired patient datasets analyzed after propensity score matching. More nurse visits ( = 0.02), fewer emergency-room visits ( = 0.01), and a shorter waiting time to access PHC ( = 0.02) were found in the community group. There was no difference in the duration of survival and hospitalization between groups. Most hospital-based patients (57%) died in hospice wards, while most community-based patients died at home (52%). Community-based PHC is comparable to hospital-based PHC in Taiwan. Although it has fewer staffing and training requirements, it is an alternative for terminal patients to meet the growing end-of-life care demand.
证据表明，基于社区的姑息治疗居家护理（PHC）能够提高连续护理质量并改善患者的预后。本研究比较了社区和医院为基础的 PHC 对患者生存、死亡地点和医疗利用的影响。本回顾性队列研究对 2018 年 5 月至 12 月期间在台湾南部一家三级医院及其周边社区接受社区或医院为基础的 PHC 的 131 名患者和 43 名社区为基础的 PHC 患者进行了研究。对 42 对经倾向评分匹配后的患者数据集进行了描述性分析、卡方检验、t 检验和对数秩检验。社区组的护士访视次数更多（=0.02），急诊室就诊次数更少（=0.01），接受 PHC 的等待时间更短（=0.02）。两组患者的生存时间和住院时间无差异。大多数医院为基础的患者（57%）在临终关怀病房死亡，而大多数社区为基础的患者（52%）在家中死亡。在台湾，社区为基础的 PHC 与医院为基础的 PHC 相当。尽管它对人员配置和培训的要求较低，但对于晚期患者来说，它是满足日益增长的临终关怀需求的一种替代选择。
