Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
Cancer. 2021 Nov 15;127(22):4249-4257. doi: 10.1002/cncr.33817. Epub 2021 Aug 10.
Healthy Days at Home (HDAH) is a novel population-based outcome measure. In this study, its use as a potential measure for cancer patients at the end of life (EOL) was explored.
Patient demographics and health care use among Medicare beneficiaries with cancer who died over the years 2014 to 2017 were identified. The HDAH was calculated by subtracting the following components from 180 days: number of days spent in inpatient and outpatient hospital observation, the emergency room, skilled nursing facilities (SNF), inpatient psychiatry, inpatient rehabilitation, long-term hospitals, and inpatient hospice. How HDAH and its components varied by beneficiary demographics and health care market were evaluated. A patient-level linear regression model with HDAH as the outcome, hospital referral region (HRR) random effects, and market fixed effects were specified, as well as beneficiary age, sex, and comorbidities as covariates.
The 294,751 beneficiaries at the EOL showed a mean number of 154.0 HDAH (out of 180 days). Inpatient (10.7 days) and SNF (9.7 days) resulted in the most substantial reductions in HDAH. Males had fewer adjusted HDAH (153.1 vs 155.7, P < .001) than females; Medicaid-eligible patients had fewer HDAH compared with non-Medicaid-eligible patients (152.0 vs 154.9; P < .001). Those with hematologic malignancies had the fewest number of HDAH (148.9). Across HRRs, HDAH ranged from 10.8 fewer to 10.9 more days than the national mean. At the HRR-level, home hospice was associated with greater HDAH, whereas home health was associated with fewer HDAH.
HDAH may be a useful measure to understand, quantify, and improve patient-centered outcomes for cancer patients at EOL.
健康在家日（HDAH）是一种新的基于人群的结局衡量指标。本研究旨在探讨其在癌症终末期患者中的应用潜力。
确定了在 2014 年至 2017 年期间患有癌症并死亡的 Medicare 受益人的人口统计学特征和医疗保健使用情况。通过从 180 天中减去以下各项来计算 HDAH：住院和门诊医院观察、急诊室、熟练护理设施（SNF）、住院精神病、住院康复、长期医院和住院临终关怀的天数。评估了 HDAH 及其组成部分如何因受益人的人口统计学特征和医疗保健市场而异。指定了以 HDAH 为结果、医院转介区域（HRR）随机效应和市场固定效应的患者水平线性回归模型，以及受益人的年龄、性别和合并症作为协变量。
在终末期的 294751 名受益人中，HDAH 的平均值为 154.0（180 天）。住院（10.7 天）和 SNF（9.7 天）导致 HDAH 减少最多。男性的调整后 HDAH 较少（153.1 比 155.7，P <.001），女性则较多；与非 Medicaid 合格患者相比，符合 Medicaid 条件的患者的 HDAH 较少（152.0 比 154.9；P <.001）。患有血液恶性肿瘤的患者的 HDAH 最少（148.9）。在各 HRR 中，HDAH 比全国平均水平少 10.8 天至多 10.9 天。在 HRR 级别上，家庭临终关怀与更大的 HDAH 相关，而家庭健康与更少的 HDAH 相关。
HDAH 可能是一种有用的衡量标准，可以了解、量化和改善癌症终末期患者的以患者为中心的结局。
