Division of General Internal Medicine & Geriatrics, Indiana University School of Medicine, Indianapolis. IN, USA.
Gastroenterology Fellowship, Department of Medicine, Indiana University School of Medicine, Indianapolis. IN, USA.
Am J Hosp Palliat Care. 2023 Jul;40(7):747-752. doi: 10.1177/10499091221127984. Epub 2022 Sep 27.
Patients with end-stage liver disease have high symptom burden and high healthcare utilization, which may be improved by palliative care consultation. We sought to determine if implementing standardized palliative care consultation criteria in hospitalized patients with end-stage liver disease would increase palliative care utilization and improve patient outcomes. We conducted a retrospective cohort study of hospitalized patients with end-stage liver disease. Patients under the age of 18, received a previous liver transplant, or admitted for liver transplantation were not included. Patients with end-stage liver disease meeting two or more of the following criteria were included: (i)Child Pugh C cirrhosis, (ii)2 or more liver related hospitalizations within 6 months, (iii) current alcohol use with alcoholic cirrhosis, and (iv) unsuitable for transplantation work up. We compared consults before and after implementation of the criteria, and we compared outcomes in patients who did and did not see palliative care. With implementation, consults increased (2/25 (8%) vs 11/33 (33%), = .020). Palliative care was associated with higher completion of health care representative documentation (66.7% vs 35.7%, = .20) and physician orders for scope of treatment forms (16.7% vs 0%, = 0.13). Patients seen by palliative care had a higher rate of discharges with hospice (30.8% vs 0, = .002). Implementation of standardized palliative care consultation criteria for patients with end-stage liver disease increased palliative care utilization. Patients seen by palliative care had increased discharges with hospice services and a trend towards higher completion rates of advanced directives.
终末期肝病患者的症状负担高，医疗保健利用率高，姑息治疗咨询可能会有所改善。我们旨在确定在终末期肝病住院患者中实施标准化姑息治疗咨询标准是否会增加姑息治疗的利用率并改善患者的结局。我们进行了一项回顾性队列研究，纳入了终末期肝病住院患者。年龄在 18 岁以下、接受过先前的肝移植或因肝移植而入院的患者不包括在内。符合以下两项或两项以上标准的终末期肝病患者包括：(i)Child Pugh C 级肝硬化；(ii)6 个月内有 2 次或以上与肝脏相关的住院治疗；(iii)当前酗酒且患有酒精性肝硬化；以及 (iv)不适合进行移植评估。我们比较了标准实施前后的咨询情况，并比较了接受和未接受姑息治疗的患者的结局。实施后，咨询量增加（2/25 (8%) vs 11/33 (33%)， =.020）。姑息治疗与更高的完成医疗代表文件（66.7% vs 35.7%， =.20）和医生下达治疗范围表格的医嘱（16.7% vs 0%， = 0.13）的比例相关。接受姑息治疗的患者出院后接受临终关怀的比例更高（30.8% vs 0%， =.002）。为终末期肝病患者实施标准化姑息治疗咨询标准可增加姑息治疗的利用率。接受姑息治疗的患者接受临终关怀服务的出院率更高，且高级指令的完成率也呈上升趋势。
