Palliative Care and Aging, Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA.
VA Palo Alto-Stanford Palliative Care Programs, Stanford School of Medicine, VA Palliative Care Quality Improvement Resource Center (QuIRC), Stanford, California, USA.
J Palliat Med. 2023 Feb;26(2):182-190. doi: 10.1089/jpm.2022.0227. Epub 2022 Sep 30.
Little is known about how local area hospice capacity and staffing levels impact hospice use in urban versus rural areas. To examine the association between local hospice capacity and staffing levels and hospice use in the context of rural disparities in hospice use, among a sample of patients with metastatic breast cancer. A retrospective cohort study using Surveillance Epidemiology End-Results (SEER)-Medicare linked data 2000-2010, Medicare Provider of Service files, and Census 2000 U.S. Zip Code Tabulation Areas files. Use of Medicare-certified hospice programs among older adults with metastatic breast cancer residing in one of the SEER program cancer registries designated by National Cancer Institute in the United States. Measurements of geographic access to hospices include urban/rural characteristics of patient residence and driving time from the nearest Medicare-certified hospice headquarter. Measurements of local-area hospice capacity and staffing levels include per capita number of Medicare-certified hospice programs and full-time employees among older adults within a predefined radius. Among the study population ( = 5418), remote and suburban areas were negatively associated with hospice use. Lower hospice use in remote and suburban areas was associated with fewer per capita number of Medicare-certified hospice program employees in local areas ≥70-minute driving radius = 0.0042), while per capita number of Medicare-certified hospice programs in local areas showed no impact. For older patients with metastatic breast cancer, availability of hospice staff, rather than driving distance or the number of hospice agencies, may limit hospice use in remote and suburban areas.
关于当地临终关怀能力和人员配备水平如何影响城市和农村地区的临终关怀使用情况，人们知之甚少。为了研究在农村地区临终关怀使用差异的背景下，当地临终关怀能力和人员配备水平与临终关怀使用之间的关联，本研究在转移性乳腺癌患者样本中进行了一项回顾性队列研究。使用监测、流行病学和最终结果（SEER）-医疗保险关联数据 2000-2010、医疗保险服务提供者文件和 2000 年美国人口普查邮政编码区文件。使用美国国家癌症研究所指定的 SEER 计划癌症登记处之一居住的患有转移性乳腺癌的老年医疗保险受益人中使用医疗保险认证的临终关怀计划。地理上获得临终关怀的衡量标准包括患者居住地的城乡特征和从最近的医疗保险认证的临终关怀总部的驾驶时间。当地临终关怀能力和人员配备水平的衡量标准包括在预定义半径内的老年人群中每人均可获得的医疗保险认证的临终关怀计划数量和全职员工数量。在研究人群中（n=5418），偏远和郊区与临终关怀的使用呈负相关。偏远和郊区临终关怀使用率较低与当地 70 分钟车程半径内每人均可获得的医疗保险认证的临终关怀项目员工人数较少有关（ = 0.0042），而当地的医疗保险认证的临终关怀计划数量则没有影响。对于患有转移性乳腺癌的老年患者来说，临终关怀人员的可用性，而不是驾驶距离或临终关怀机构的数量，可能会限制偏远和郊区的临终关怀使用。
