居家健康照护在生命末期的社区居住老年人中的作用：是否超越临终关怀？
Role of Home Health for Community-Dwelling Older Adults Near the End of Life: A Resource Beyond Hospice?
机构信息
San Francisco VA Health Care System, San Francisco, California, USA.
Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, California, USA.
出版信息
J Palliat Med. 2023 Mar;26(3):385-392. doi: 10.1089/jpm.2022.0272. Epub 2022 Sep 22.
Medicare home health could be leveraged to care for those near the end of life (EOL), especially for those who cannot access nor desire the Medicare hospice benefit. It is unknown what role home health currently has either preceding or as an alternative to hospice use. The aim of this study is to compare populations served and visit patterns of Medicare beneficiaries receiving home health/hospice/both near the EOL. Nationally representative cohort study of National Health and Aging Trends Study (NHATS) respondents. A total of 1,057 U.S. decedents in NHATS from 2012 to 2017 with linked Medicare claims were included in this study. Measurements included the proportion of decedents who received home health/hospice/both/neither (yes/no) in the last six months of life (EOL) and mean number of visits by discipline (nurse/therapist [physical/occupational speech-language pathologist]/social worker/home health aide) per 30 eligible days at home for home health/hospice/both at the EOL. The primary independent variable was the clinician discipline providing services (nurse/therapist/social worker/aide). In our sample, 19.9% received home health only, 25.8% hospice only, 18.8% both, and 35.6% neither at the EOL. These populations varied in their demographic, region, and clinical characteristics. Decedents who received home health only compared with hospice only were younger (44.1% over age 85 vs. 58.4%), members of a racially/ethnically diverse group (19.7% vs. 10.9%), and with less disability (37.2% required no assistance with activities of daily living vs. 22.7%), all values <0.05. In adjusted models, those receiving home health versus hospice received similar numbers of visits per 30 days (average 5.4/30 vs. 6.6/30), while those receiving both received more visits (10.5/30). Home health provided more therapy visits, while hospice provided more social work and aide visits. More than one in three Medicare decedents nationwide received home health at the EOL. Home health has the potential to serve a population not reached by hospice and improve the quality of end-of-life care.
医疗保险家庭保健可以被利用来照顾那些生命末期（EOL）的人，特别是那些无法获得或不希望获得医疗保险临终关怀福利的人。目前尚不清楚家庭保健在临终关怀之前或作为替代临终关怀的作用是什么。本研究的目的是比较接受家庭保健/临终关怀/两者的医疗保险受益人的服务人群和就诊模式。全国健康老龄化趋势研究（NHATS）的全国代表性队列研究。2012 年至 2017 年期间，NHATS 中有 1057 名美国死者与医疗保险索赔相关联，包括在本研究中。测量包括在生命末期（EOL）的最后六个月内接受家庭保健/临终关怀/两者/两者均不接受的死者比例（是/否），以及在家庭保健/临终关怀的 EOL 时，每 30 个符合条件的在家日，由家庭保健/临终关怀/两者的护理人员（护士/治疗师[物理/职业言语语言病理学家]/社会工作者/家庭保健助理）提供的服务的平均就诊次数。主要的独立变量是提供服务的临床医生（护士/治疗师/社会工作者/助理）。在我们的样本中，19.9%只接受家庭保健，25.8%只接受临终关怀，18.8%两者都接受，35.6%两者均不接受。这些人群在人口统计学、地区和临床特征方面存在差异。只接受家庭保健的死者与只接受临终关怀的死者相比，年龄更小（44.1%年龄在 85 岁以上，而 58.4%年龄在 85 岁以上），种族/族裔群体更多样化（19.7%，而 10.9%），残疾程度更低（37.2%不需要日常活动的帮助，而 22.7%需要帮助），所有值均<0.05。在调整后的模型中，与接受临终关怀相比，接受家庭保健的患者每 30 天接受的就诊次数相似（平均 5.4/30 与 6.6/30），而接受两者的患者接受的就诊次数更多（10.5/30）。家庭保健提供更多的治疗就诊，而临终关怀提供更多的社会工作者和助理就诊。全国有超过三分之一的医疗保险死者在生命末期接受家庭保健。家庭保健有可能为未接受临终关怀的人群提供服务，并提高临终关怀质量。
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