Kozhevnikov Dmitry, Loho Hieronimus, Prestia Brett
Yale School of Medicine, New Haven, Connecticut, USA.
Yale Palliative Care Program, New Haven, Connecticut, USA.
J Palliat Med. 2023 Aug;26(8):1048-1055. doi: 10.1089/jpm.2022.0460. Epub 2023 Jan 30.
Patients with serious illness may elect to transition their care to comfort measures only (CMO) while in the hospital. Although studies have shown that routine hospice care is underutilized, the rate of general inpatient hospice (GIP) use among CMO patients during their terminal admission remains unclear. We sought to (1) examine the rate of GIP utilization and (2) identify factors associated with its use among hospitalized CMO decedents. CMO decedents in two academic, tertiary care hospitals in the United States who died between October 1, 2020 and October 31, 2021, were subgrouped based on their primary medical service (GIP vs. non-GIP) at the time of inpatient death. Data abstracted from the electronic health record included demographics, primary diagnosis codes, Rothman Index (RI), time of CMO order, ordering clinician type, time of death, and length of stay (LOS). Multivariable logistic regression analysis was performed, adjusting for relevant covariates. Of 1475 CMO decedents, only 321 ( = 22%) patients received GIP. On multivariable analysis, CMO patients who died in an ICU were five times less likely (odds ratio [OR] = 0.18, confidence interval [95% CI] 0.11-0.29) to receive GIP. Every 10-point increase in RI raised the likelihood of receiving GIP by 59% (OR = 1.59, 95% CI 1.39-1.80). Most CMO decedents died in the hospital without GIP. Compared with GIP decedents, non-GIP decedents were less acutely ill. There was no difference in total LOS between the two groups. CMO decedents were much less likely to receive GIP in an ICU. The RI may help clinicians identify CMO patients who would benefit from GIP earlier in their terminal admission.
患有严重疾病的患者在住院期间可能会选择仅接受舒缓治疗措施（CMO）。尽管研究表明常规临终关怀服务未得到充分利用，但CMO患者在其临终住院期间使用普通住院临终关怀（GIP）的比例仍不清楚。我们试图（1）研究GIP的使用比例，以及（2）确定住院CMO死者中与使用GIP相关的因素。对2020年10月1日至2021年10月31日期间在美国两家学术性三级护理医院死亡的CMO死者，根据其住院死亡时的主要医疗服务（GIP与非GIP）进行分组。从电子健康记录中提取的数据包括人口统计学信息、主要诊断代码、罗斯曼指数（RI）、CMO医嘱时间、开医嘱的临床医生类型、死亡时间和住院时长（LOS）。进行了多变量逻辑回归分析，并对相关协变量进行了调整。在1475例CMO死者中，只有321例（=22%）患者接受了GIP。在多变量分析中，在重症监护病房（ICU）死亡的CMO患者接受GIP的可能性降低了五倍（优势比[OR]=0.18，置信区间[95%CI]0.11 - 0.29）。RI每增加10分，接受GIP的可能性就提高59%（OR = 1.59，95%CI 1.39 - 1.80）。大多数CMO死者在没有接受GIP的情况下在医院死亡。与接受GIP的死者相比，未接受GIP的死者病情不太严重。两组的总住院时长没有差异。CMO死者在ICU接受GIP的可能性要小得多。RI可能有助于临床医生在CMO患者临终住院早期识别出可能从GIP中获益的患者。
