癌症患者生命终末期初级和社区保健服务与急诊就诊和住院的关联：一项回顾性队列研究。

Association of primary and community care services with emergency visits and hospital admissions at the end of life in people with cancer: a retrospective cohort study.

机构信息

Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK

Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.

出版信息

BMJ Open. 2022 Feb 23;12(2):e054281. doi: 10.1136/bmjopen-2021-054281.

DOI:10.1136/bmjopen-2021-054281

PMID:35197345

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8867349/

Abstract

OBJECTIVE

To examine the association between primary and community care use and measures of acute hospital use in people with cancer at the end of life.

DESIGN

Retrospective cohort study.

SETTING

We used Discover, a linked administrative and clinical data set from general practices, community and hospital records in North West London (UK).

PARTICIPANTS

People registered in general practices, with a diagnosis of cancer who died between 2016 and 2019.

PRIMARY AND SECONDARY OUTCOME MEASURES

≥3 hospital admissions during the last 90 days, ≥1 admissions in the last 30 days and ≥1 emergency department (ED) visit in the last 2 weeks of life.

RESULTS

Of 3581 people, 490 (13.7%) had ≥3 admissions in last 90 days, 1640 (45.8%) had ≥1 admission in the last 30 days, 1042 (28.6%) had ≥1 ED visits in the last 2 weeks; 1069 (29.9%) had more than one of these indicators. Contacts with community nurses in the last 3 months (≥13 vs <4) were associated with fewer admissions in the last 30 days (risk ratio (RR) 0.88, 95% CI 0.90 to 0.98) and ED visits in the last 2 weeks of life (RR 0.79, 95% CI 0.68 to 0.92). Contacts with general practitioners in the last 3 months (≥11 vs <4) was associated with higher risk of ≥3 admissions in the last 90 days (RR 1.63, 95% CI 1.33 to 1.99) and ED visits in the last 2 weeks of life (RR 1.27, 95% CI 1.10 to 1.47).

CONCLUSIONS

Expanding community nursing could reduce acute hospital use at the end of life and improve quality of care.

摘要

目的

研究终末期癌症患者的初级保健和社区护理使用情况与急性医院使用情况之间的关联。

设计

回顾性队列研究。

设置

我们使用了来自英国伦敦西北部的全科医生、社区和医院记录的链接管理和临床数据集 Discover。

参与者

在全科医生处登记，患有癌症且在 2016 年至 2019 年期间死亡的人。

主要和次要结果测量

在过去 90 天内≥3 次住院、过去 30 天内≥1 次住院和生命最后 2 周内≥1 次急诊部（ED）就诊。

结果

在 3581 人中，有 490 人（13.7%）在过去 90 天内有≥3 次住院，1640 人（45.8%）在过去 30 天内有≥1 次住院，1042 人（28.6%）在过去 2 周内有≥1 次 ED 就诊；1069 人（29.9%）有多个这些指标。在过去 3 个月内与社区护士的接触（≥13 次与<4 次）与生命最后 30 天内的住院次数减少（风险比（RR）0.88，95%置信区间 0.90 至 0.98）和生命最后 2 周内的 ED 就诊次数减少（RR 0.79，95%置信区间 0.68 至 0.92）有关。在过去 3 个月内与全科医生的接触（≥11 次与<4 次）与生命最后 90 天内≥3 次住院的风险增加有关（RR 1.63，95%置信区间 1.33 至 1.99）和生命最后 2 周内的 ED 就诊次数增加（RR 1.27，95%置信区间 1.10 至 1.47）。