医疗保险患者在临终关怀出院后接受医疗服务的利用情况和死亡率，以及阿尔茨海默病和相关痴呆症患者和非阿尔茨海默病和相关痴呆症患者的比较。
Healthcare Utilization and Mortality After Hospice Live Discharge Among Medicare Patients With and Without Alzheimer's Disease and Related Dementias.
机构信息
Department of Population Health Sciences, Weill Medical College of Cornell University, 402 East 67th Street, New York, NY, 10065, USA.
Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA.
出版信息
J Gen Intern Med. 2023 Aug;38(10):2272-2278. doi: 10.1007/s11606-023-08031-8. Epub 2023 Jan 17.
BACKGROUND
Little is known about post-discharge outcomes among patients who were discharged alive from hospice.
OBJECTIVE
To compare healthcare utilization and mortality after hospice live discharge among Medicare patients with and without Alzheimer's disease and related dementias (ADRD).
DESIGN
Retrospective cohort study using Medicare claims data of a 20% random sample of Medicare fee-for-service (FFS) patients.
PARTICIPANTS
A total of 153,696 Medicare FFS patients experienced live discharge from hospice between 2014 and 2019.
MEASURES
Two types of burdensome transition (type 1: live discharge from hospice followed by hospitalization and subsequent hospice readmission; type 2: live discharge from hospice followed by hospitalization with the patient deceased in the hospital), acute care utilization, hospice readmission, and mortality in the 30 and 180 days after live discharge and between live discharge and death.
RESULTS
Compared with non-ADRD patients, ADRD patients were less likely to experience burdensome transitions (type 1: adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.90-0.98; type 2: aOR, 0.70; 95% CI, 0.65-0.75), more likely to have ED visits (aOR, 1.05; 95% CI, 1.01-1.09), less likely to die (aOR, 0.71; 95% CI, 0.69-0.73), and less likely to be readmitted to hospice (aOR, 0.86; 95% CI, 0.84-0.89) 30 days after live discharge. Results of 180-day post-discharge outcomes were largely consistent with results of 30-day outcomes. Among patients who died as of December 31, 2019, ADRD patients were less likely to be hospitalized (aOR, 0.88; 95% CI, 0.85-0.92) and more likely to be readmitted to hospice (aOR, 1.12; 95% CI, 1.08-1.16) between live discharge and death. Significant racial/ethnicity disparities in acute care utilization and mortality after live discharge existed in both ADRD and non-ADRD groups.
CONCLUSION
ADRD patients had lower mortality, a longer survival time, a lower rate of hospitalization, and an initially lower but gradually increasing rate of hospice readmission than non-ADRD patients after hospice live discharge. These different trajectories warrant further investigation of the eligibility of their initial hospice enrollment. Black patients had significantly worse outcomes after hospice live discharge compared with White patients.
背景
对于从临终关怀机构活着出院的患者，人们对其出院后的结局知之甚少。
目的
比较接受临终关怀后活着出院的伴有和不伴有阿尔茨海默病及相关痴呆症（ADRD）的医疗保险患者的医疗保健利用情况和死亡率。
设计
使用医疗保险索赔数据的回顾性队列研究，对医疗保险按服务付费（FFS）患者的 20%随机样本进行研究。
参与者
共有 153696 名医疗保险 FFS 患者在 2014 年至 2019 年间从临终关怀机构活着出院。
测量指标
两种类型的负担过重的过渡（类型 1：从临终关怀机构活着出院后住院并随后再次入住临终关怀机构；类型 2：从临终关怀机构活着出院后住院且患者在医院死亡）、急性护理利用情况、再次入住临终关怀机构和出院后 30 天和 180 天及从出院到死亡期间的死亡率。
结果
与非 ADRD 患者相比，ADRD 患者发生负担过重的过渡（类型 1：调整后的优势比 [aOR]，0.94；95%置信区间 [CI]，0.90-0.98；类型 2：aOR，0.70；95% CI，0.65-0.75）的可能性较低，更有可能到急诊就诊（aOR，1.05；95% CI，1.01-1.09），不太可能死亡（aOR，0.71；95% CI，0.69-0.73），再次入住临终关怀机构的可能性较低（aOR，0.86；95% CI，0.84-0.89），在出院后 30 天。出院后 180 天的结果与出院后 30 天的结果基本一致。截至 2019 年 12 月 31 日死亡的患者中，ADRD 患者住院的可能性较低（aOR，0.88；95% CI，0.85-0.92），再次入住临终关怀机构的可能性较高（aOR，1.12；95% CI，1.08-1.16），从出院到死亡。ADRD 患者和非 ADRD 患者出院后，在急性护理利用和死亡率方面都存在显著的种族/民族差异。
结论
与非 ADRD 患者相比，ADRD 患者在从临终关怀机构活着出院后，死亡率较低，生存时间较长，住院率较低，最初较低但逐渐增加的再次入住临终关怀机构的比率。这些不同的轨迹需要进一步调查他们最初参与临终关怀的资格。与白人患者相比，黑人患者从临终关怀机构活着出院后的结局明显较差。
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