Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Bruyère Research Institute, Ottawa, Ontario, Canada.
J Palliat Med. 2022 Jun;25(6):897-906. doi: 10.1089/jpm.2021.0496. Epub 2022 Jan 10.
For hospitalized patients with palliative care needs, there is little evidence on whether postdischarge outcomes differ if inpatient palliative care was delivered by a palliative care specialist or nonspecialist/generalist. To evaluate relationships between inpatient palliative care involvement and physician-delivered palliative care in the community after hospital discharge among individuals with limited life expectancy. Population-based retrospective cohort study using administrative health data. Adults with a predicted median survival of six months or less admitted to acute care hospitals in Ontario, Canada, between April 1, 2013, and March 31, 2017, and discharged to the community. Inpatient palliative care involvement was classified as high (e.g., palliative care unit), medium (e.g., palliative care specialist consult), low (e.g., generalist-delivered palliative care), or none. Community palliative care included outpatient and home and clinic visits three weeks postdischarge. Among 3660 hospitalized adults, 82 (2.2%) received inpatient palliative care with high level of involvement, 462 (12.6%) with medium level of involvement, 525 (14.3%) with low level of involvement, and 2591 (70.8%) had no inpatient palliative care. Patients who received inpatient palliative care were more likely to receive community palliative care after discharge than those who received no inpatient palliative care. These associations were stronger among patients who received high/medium palliative care involvement than patients who received low palliative care involvement. Inpatient palliative care, including that delivered by generalists, is associated with an increased likelihood of community palliative care after discharge. Increased inpatient generalist palliative care may help support patients' palliative care needs.
对于有姑息治疗需求的住院患者，如果姑息治疗是由姑息治疗专家还是非专家/通科医生提供，出院后的结局是否存在差异，目前这方面的证据有限。本研究旨在评估在预期生存时间有限的个体中，住院姑息治疗的参与情况与出院后社区中医生提供的姑息治疗之间的关系。这是一项基于人群的回顾性队列研究，使用了行政健康数据。2013 年 4 月 1 日至 2017 年 3 月 31 日期间，加拿大安大略省的急性护理医院收治了预计中位生存期为 6 个月或更短的成年人，并出院到社区。将住院姑息治疗的参与情况分为高（例如姑息治疗病房）、中（例如姑息治疗专家会诊）、低（例如通科医生提供的姑息治疗）或无。社区姑息治疗包括出院后 3 周内的门诊和家庭及诊所就诊。在 3660 名住院成年人中，82 名（2.2%）接受了高参与度的住院姑息治疗，462 名（12.6%）接受了中参与度的姑息治疗，525 名（14.3%）接受了低参与度的姑息治疗，2591 名（70.8%）未接受住院姑息治疗。与未接受住院姑息治疗的患者相比，接受住院姑息治疗的患者在出院后更有可能接受社区姑息治疗。在接受高/中姑息治疗参与度的患者中，这种关联比接受低姑息治疗参与度的患者更强。住院姑息治疗，包括由通科医生提供的姑息治疗，与出院后社区姑息治疗的可能性增加相关。增加住院通科姑息治疗可能有助于满足患者的姑息治疗需求。
