Rhode Island Hospital and Lifespan Health System of Providence (A.L.G., J.R., J.M.S., S.E., W.C.W.), RI, USA.
Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA.
J Pain Symptom Manage. 2022 Nov;64(5):471-477. doi: 10.1016/j.jpainsymman.2022.07.010. Epub 2022 Jul 25.
Patients experiencing housing insecurity have numerous barriers affecting their utilization of medical care.
Determine if housing insecurity is associated with palliative care (PC) encounters and hospice services in patients with heart failure who receive care in United States Veterans Affairs (VA) medical centers.
This retrospective study included inpatients in VA hospitals with a primary diagnosis of congestive heart failure from 2010 to 2020. Housing stability was collected from coding and separated into three cohorts: at risk for homelessness, experiencing homelessness, and stably housed. The primary outcome was a PC encounter during admission and the stably housed cohort was used as the analytic reference. Inverse-probability-weighting (IPTW) was calculated to adjust the likelihood of receiving PC during the index admission.
Seventy thousand eight hundred fourty nine veterans were identified. Veterans were identified as at risk for homelessness (n=4039, 5.7%), experiencing homelessness (n=1967, 2.8%) and stably housed (n=64,843, 91.5%). PC was delivered to veterans at risk for homelessness (n=484, 12.0%), veterans experiencing homelessness, (n=161, 8.2%) and patients with stable housing (n=6249, 9.6%). Relative to the stably housed and adjusted for IPTW, those at risk for homelessness received PC services similarly (adjusted OR=1.06, 95% CI 0.94,1.19) and those experiencing homelessness were at lower odds of receiving PC services (adjusted OR=0.62, 95% CI 0.52,0.75).
Housing stability may be a factor in Veterans receiving PC during hospitalization for heart failure. While the logistical challenges of delivering PC and hospice to people experiencing homelessness are daunting, advocating for these services shows commitment to reducing suffering in life-limiting Illness.
住房无保障的患者在利用医疗保健方面存在诸多障碍。
确定在美国退伍军人事务部 (VA) 医疗中心接受治疗的心力衰竭患者中，住房无保障是否与姑息治疗 (PC) 就诊和临终关怀服务相关。
这项回顾性研究纳入了 2010 年至 2020 年期间 VA 医院因充血性心力衰竭住院的患者，其主要诊断为充血性心力衰竭。通过编码收集住房稳定性，并分为三个队列：有住房风险、无家可归、住房稳定。主要结果是在住院期间进行 PC 就诊，并且以稳定住房队列作为分析参考。采用逆概率加权 (IPTW) 计算来调整在指数住院期间接受 PC 的可能性。
确定了 70849 名退伍军人。退伍军人被确定为有住房风险（n=4039，5.7%）、无家可归（n=1967，2.8%）和住房稳定（n=64843，91.5%）。有住房风险的退伍军人（n=484，12.0%）、无家可归的退伍军人（n=161，8.2%）和住房稳定的患者（n=6249，9.6%）接受了 PC 服务。与住房稳定且经 IPTW 调整相比，有住房风险的退伍军人接受 PC 服务的可能性相似（调整后的 OR=1.06，95%CI 0.94，1.19），而无家可归的退伍军人接受 PC 服务的可能性较低（调整后的 OR=0.62，95%CI 0.52，0.75）。
住房稳定性可能是退伍军人在因心力衰竭住院期间接受 PC 的一个因素。虽然向无家可归者提供 PC 和临终关怀服务在后勤方面具有挑战性，但倡导这些服务表明致力于减轻危及生命的疾病中的痛苦。
