姑息治疗资源的利用率仍然较低，可能导致 IV 期非小细胞肺癌患者不必要的住院治疗：一项基于社区的回顾性研究。

Utilization of palliative care resource remains low, consuming potentially avoidable hospital admissions in stage IV non-small cell lung cancer: a community-based retrospective review.

机构信息

Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 850, Seattle, WA, 98104, USA.

Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence St. Joseph Health, Portland, OR, USA.

出版信息

Support Care Cancer. 2022 Dec;30(12):10117-10126. doi: 10.1007/s00520-022-07364-0. Epub 2022 Nov 14.

DOI:10.1007/s00520-022-07364-0

PMID:36374328

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9661463/

Abstract

PURPOSE

Early referral of patients with stage IV non-small cell lung cancer (NSCLC) to outpatient palliative care has been shown to increase survival and reduce unnecessary healthcare resource utilization. We aimed to determine outpatient palliative care referral rate and subsequent resource utilization in patients with stage IV NSCLC in a multistate, community-based hospital network and identify rates and reasons for admissions within a local healthcare system of Washington State.

METHODS

A retrospective chart review of a multistate hospital network and a local healthcare system. Patients were identified using ICD billing codes. In the multistate network, 2844 patients diagnosed with stage IV NSCLC between January 1, 2013, and March 1, 2018, were reviewed. In the state healthcare system, 283 patients between August 2014 and June 2017 were reviewed.

RESULTS

Referral for outpatient palliative care was low: 8% (217/2844) in the multistate network and 11% (32/283) in the local healthcare system. Early outpatient palliative care (6%, 10/156) was associated with a lower proportion of patients admitted into the intensive care unit in the last 30 days of life compared to no outpatient palliative care (15%, 399/2627; p = 0.003). Outpatient palliative care referral was associated with improved overall survival in Kaplan Meier survival analysis. Within the local system, 51% (104/204) of admissions could have been managed in outpatient setting, and of the patients admitted in the last 30 days of life, 59% (87/147) experienced in-hospital deaths.

CONCLUSION

We identified underutilization of outpatient palliative care services within stage IV NSCLC patients. Many patients with NSCLC experience hospitalization the last month of life and in-hospital death.

摘要

目的

将患有 IV 期非小细胞肺癌（NSCLC）的患者尽早转至门诊姑息治疗，已被证明可提高生存率并减少不必要的医疗资源利用。我们旨在确定在一个多州的社区医院网络和华盛顿州当地医疗保健系统中，IV 期 NSCLC 患者的门诊姑息治疗转介率和随后的资源利用情况，并确定当地医疗保健系统内的住院率和原因。

方法

对一个多州医院网络和当地医疗保健系统进行回顾性病历审查。使用 ICD 计费代码识别患者。在多州网络中，共审查了 2013 年 1 月 1 日至 2018 年 3 月 1 日期间被诊断患有 IV 期 NSCLC 的 2844 名患者。在州内医疗保健系统中，共审查了 2014 年 8 月至 2017 年 6 月期间的 283 名患者。

结果

门诊姑息治疗的转介率较低：多州网络中为 8%（217/2844），当地医疗保健系统中为 11%（32/283）。早期门诊姑息治疗（6%，10/156）与在生命的最后 30 天内进入重症监护病房的患者比例较低相关，与无门诊姑息治疗（15%，399/2627；p=0.003）相比。在 Kaplan-Meier 生存分析中，门诊姑息治疗的转介与总生存率的提高相关。在当地系统中，51%（104/204）的入院可以在门诊环境中进行管理，在生命的最后 30 天内入院的患者中，59%（87/147）经历院内死亡。