儿科同期临终关怀对改善连续性护理的效果。
Effectiveness of Pediatric Concurrent Hospice Care to Improve Continuity of Care.
机构信息
College of Nursing, 16166University of Tennessee, Knoxville, TN, USA.
Department of Health Services Policy and Management, 2629University of South Carolina, Columbia, SC, USA.
出版信息
Am J Hosp Palliat Care. 2022 Oct;39(10):1129-1136. doi: 10.1177/10499091211056039. Epub 2021 Dec 4.
BACKGROUND
The 2010 Patient Protection and Affordable Care Act (ACA) mandated landmark hospice care legislation for children at end of life. Little is known about the impact of pediatric concurrent hospice care.
OBJECTIVE
The purpose of this study was to examine the effect of pediatric concurrent vs standard hospice care on end-of-life care continuity among Medicaid beneficiaries.
METHODS
Using national Medicaid data, we conducted a quasi-experimental designed study to estimate the effect of concurrent vs standard hospice care to improve end-of-life care continuity for children. Care continuity (i.e., hospice length of stay, hospice disenrollment, emergency room transition, and inpatient transition) was measured via claims data. Exposures were concurrent hospice vs standard hospice care. Using instrumental variable analysis, the effectiveness of exposures on care continuity was compared.
RESULTS
Concurrent hospice care affected care continuity. It resulted in longer lengths of stays in hospice ( = 2.76, < .001) and reduced hospice live discharges ( = -2.80, < .05), compared to standard hospice care. Concurrent care was not effective at reducing emergency room ( = 2.09, < .001) or inpatient care ( = .007, < .05) transitions during hospice enrollment.
CONCLUSION
Our study provides critical insight into the quality of care delivered for children at end of life. These findings have policy implications.
背景
2010 年《患者保护与平价医疗法案》（ACA）要求在生命末期为儿童提供具有里程碑意义的临终关怀立法。关于儿科同时接受临终关怀的影响知之甚少。
目的
本研究旨在探讨儿科同时接受临终关怀与标准临终关怀对医疗补助受益人的临终关怀连续性的影响。
方法
利用国家医疗补助数据，我们进行了一项准实验设计研究，以评估同时接受临终关怀与标准临终关怀对改善儿童临终关怀连续性的效果。通过索赔数据来衡量护理连续性（即临终关怀住院时间、临终关怀退出、急诊过渡和住院过渡）。暴露因素是同时接受临终关怀与标准临终关怀。采用工具变量分析，比较了暴露因素对护理连续性的影响。
结果
同时接受临终关怀会影响护理连续性。与标准临终关怀相比，它导致更长的临终关怀住院时间（=2.76，<0.001）和减少临终关怀存活出院（=−2.80，<0.05）。同时接受临终关怀并不能有效减少急诊（=2.09，<0.001）或住院（=0.007，<0.05）期间的过渡。
结论
我们的研究为生命末期儿童提供的护理质量提供了重要的见解。这些发现具有政策意义。
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