Division of Rheumatology, Hallym University Sacred Heart Hospital, Anyang, Korea.
Institute for Skeletal Aging, Hallym University, Chuncheon, Korea.
J Korean Med Sci. 2023 Mar 27;38(12):e98. doi: 10.3346/jkms.2023.38.e98.
To analyze the trends in laboratory and imaging test use 1 week before death among decedents who died in Korean hospitals, tests used per decedents from 2006 to 2015 were examined by using the National Health Insurance Service-Elderly Sample Cohort (NHIS-ESC) dataset.
The study population consisted of decedents aged ≥ 60 years old with a history of admission and death at a hospital, and tests recorded in the payment claims for laboratory and imaging tests according to the Healthcare Common Procedure Coding System codes were examined. Twenty-eight laboratory and 6 imaging tests were selected. For each year, crude rates of test use per decedents in each age and sex stratum were calculated. Regression analysis was used to examine the temporal changes in the test use.
During the follow-up period, 6,638 subjects included in the sample cohort died. The number of total laboratory and imaging tests performed on the deceased increased steadily throughout the study year from 10.3 tests/deceased in 2006 to 16.6 tests/deceased in 2015. The use of tests increased significantly in general hospitals, however, not in nursing hospitals. Laboratory tests showed yearly increase, from 9.46/deceased in 2006 to 15.57/deceased in 2015, an annual increase of 7.39%. On the other hand, the use of imaging increased from 0.86/deceased in 2006 to 1.01/deceased in 2015, which was not statistically significant.
The use of tests, especially laboratory tests, increased steadily over the years even among those elderly patients at imminent death. Reducing acute healthcare at the end of life would be one target not only to support the sustainability of the health care budget but also to improve the quality of dying and death.
本研究利用韩国国民健康保险服务-老年人样本队列（NHIS-ESC）数据库，分析了 2006 年至 2015 年间在韩国医院死亡的死者在死亡前一周的实验室和影像学检查使用趋势。
研究人群为有住院和死亡史且年龄≥60 岁的死者，根据医疗保健通用程序编码系统（Healthcare Common Procedure Coding System）代码，对实验室和影像学检查的支付索赔中记录的检查进行了检查。选择了 28 项实验室检查和 6 项影像学检查。计算了每年各年龄和性别组死者检查使用的粗率。采用回归分析方法考察检查使用的时间变化。
在随访期间，样本队列中共有 6638 名受试者死亡。研究年内，死者接受的总实验室和影像学检查数量稳步增加，从 2006 年的每死者 10.3 次检查增加到 2015 年的每死者 16.6 次检查。综合医院的检查使用率显著增加，但护理院没有增加。实验室检查呈逐年增加趋势，从 2006 年的每死者 9.46 次检查增加到 2015 年的每死者 15.57 次检查，年增长率为 7.39%。另一方面，影像学检查的使用从 2006 年的每死者 0.86 次检查增加到 2015 年的每死者 1.01 次检查，但无统计学意义。
即使是在生命末期即将死亡的老年患者中，检查的使用，尤其是实验室检查的使用也在逐年稳步增加。减少生命末期的急性医疗保健不仅是支持医疗保健预算可持续性的一个目标，也是提高临终和死亡质量的一个目标。
