专科姑息治疗团队及相关转诊率特征：荷兰全国医院横断面调查。
Specialist palliative care teams and characteristics related to referral rate: a national cross-sectional survey among hospitals in the Netherlands.
机构信息
Netherlands Comprehensive Cancer Organisation (IKNL), P.O. Box 19079, 3501 DB, Utrecht, the Netherlands.
Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands.
出版信息
BMC Palliat Care. 2021 Nov 11;20(1):175. doi: 10.1186/s12904-021-00875-3.
BACKGROUND
Specialist palliative care teams (SPCTs) in hospitals improve quality of life and satisfaction with care for patients with advanced disease. However, referrals to SPCTs are often limited. To identify areas for improvement of SPCTs' service penetration, we explored the characteristics and level of integration of palliative care programmes and SPCTs in Dutch hospitals and we assessed the relation between these characteristics and specialist palliative care referral rates.
METHODS
We performed a secondary analysis of a national cross-sectional survey conducted among hospitals in the Netherlands from March through May 2018. For this survey, a previously developed online questionnaire, containing 6 consensus-based integration indicators, was sent to palliative care programme leaders in all 78 hospitals. For referral rate we calculated the number of annual inpatient referrals to the SPCT as a percentage of the number of total annual hospital admissions. Referral rate was dichotomized into high (≥ third quartile) and low (< third quartile). Characteristics of SPCTs with high and low referral rate were compared using univariate analyses. P-values < 0.05 were considered significant.
RESULTS
In total, 63 hospitals (81%) participated in the survey, of which 62 had an operational SPCT. The palliative care programmes of these hospitals consisted of inpatient consultation services (94%), interdisciplinary staffing (61%), outpatient clinics (45%), dedicated acute care beds (21%) and community-based palliative care (27%). The median referral rate was 0.56% (IQR 0.23-1.0%), ranging from 0 to 3.7%. Comparing SPCTs with high referral rate (≥1%, n = 17) and low referral rate (< 1%, n = 45) showed significant differences for SPCTs' years of existence, staffing, their level of education, participation in other departments' team meetings, provision of education and conducting research. With regard to integration, significant differences were found for the presence of outpatient clinics and timing of referrals.
CONCLUSION
In the Netherlands, palliative care programmes and specialist palliative care teams in hospitals vary in their level of integration and development, with more mature teams showing higher referral rates. Appropriate staffing, dedicated outpatient clinics, education and research appear means to improve service penetration and timing of referral for patients with advanced diseases.
背景
医院的专科姑息治疗团队（SPCT）可以提高晚期疾病患者的生活质量和对护理的满意度。然而，向 SPCT 的转诊通常受到限制。为了确定提高 SPCT 服务渗透度的改进领域，我们探讨了荷兰医院姑息治疗计划和 SPCT 的特点和整合程度，并评估了这些特点与专科姑息治疗转诊率之间的关系。
方法
我们对 2018 年 3 月至 5 月期间在荷兰医院进行的一项全国性横断面调查进行了二次分析。对于这项调查，我们向所有 78 家医院的姑息治疗计划负责人发送了一份先前开发的在线问卷，其中包含 6 个基于共识的整合指标。为了计算转诊率，我们将 SPCT 的年度住院患者转诊人数除以年度总住院人数。转诊率分为高（≥第三四分位数）和低（<第三四分位数）。使用单变量分析比较转诊率高（≥第三四分位数）和低（<第三四分位数）的 SPCT 的特征。P 值<0.05 被认为具有统计学意义。
结果
共有 63 家医院（81%）参与了调查，其中 62 家医院有运作中的 SPCT。这些医院的姑息治疗计划包括住院咨询服务（94%）、跨学科人员配备（61%）、门诊诊所（45%）、专门的急性护理床位（21%）和社区姑息治疗（27%）。中位转诊率为 0.56%（IQR 0.23-1.0%），范围为 0 至 3.7%。比较转诊率高（≥1%，n=17）和低（<1%，n=45）的 SPCT 显示 SPCT 的存在年限、人员配备、教育水平、参与其他部门的团队会议、提供教育和开展研究方面存在显著差异。在整合方面，门诊诊所的存在和转诊时间存在显著差异。
结论
在荷兰，医院的姑息治疗计划和 SPCT 在整合和发展水平上存在差异，更成熟的团队转诊率更高。适当的人员配备、专门的门诊诊所、教育和研究似乎是提高晚期疾病患者服务渗透度和转诊时间的手段。
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