Department of Health Sciences, Helsana Group, Zürich, Switzerland.
Department of General Practice, Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur J Public Health. 2023 Jun 1;33(3):396-402. doi: 10.1093/eurpub/ckad047.
Continuity of care (COC) was shown to be associated with fewer hospitalizations. We aimed to evaluate whether COC was associated with intensive intervention(s) at the end of life (IEOL), a preference-sensitive outcome, in cancer patients.
The study is based on claims data of patients with incident use of anti-neoplastics in Switzerland. COC Index, Usual Provider Continuity score, Sequential Continuity index and Modified Modified Continuity Index were calculated based on consultations with the usual ambulatory care physician. Treatment intensity was evaluated in the last 6 months of life, and COC was evaluated in months 18-6 before death in those who died between 24 and 54 months after incident cancer. IEOL comprised life-sustaining interventions (cardiac catheterization, cardiac assistance device implantation, pulmonary artery wedge monitoring, cardiopulmonary resuscitation/cardiac conversion, gastrostomy, blood transfusion, dialysis, mechanical ventilator utilization and intravenous antibiotics) and measures specifically used in cancer patients (last dose of chemotherapy ≤14 days of death, a new chemotherapy regimen starting <30 days before death, ≥1 emergency visit in the last month of life, ≥1 hospital admission or spending >14 days in hospital in the last month of life and death in an acute-care hospital).
All COC scores were inversely associated with the occurrence of an IEOL, as were older age, homecare nursing utilization and density of ambulatory care physicians. For COC Index, odds ratio was 0.55 (95% confidence interval 0.37-0.83).
COC scores were consistently and inversely related to IEOL. The study supports efforts to improve COC for cancer patients at their end of life.
连续性护理（COC）与减少住院治疗相关。我们旨在评估 COC 是否与癌症患者生命末期（IEOL）的强化干预（s）相关，这是一个偏好敏感的结果。
该研究基于瑞士接受抗肿瘤药物治疗的患者的索赔数据。COC 指数、常规提供者连续性评分、连续顺序指数和改良连续指数是根据与常规门诊医生的就诊计算得出的。在生命的最后 6 个月评估治疗强度，并在癌症发病后 24 至 54 个月内死亡的患者中，在死亡前 18-6 个月评估 COC。IEOL 包括生命维持干预（心导管检查、心脏辅助设备植入、肺动脉楔压监测、心肺复苏/心脏转换、胃造口术、输血、透析、机械通气利用和静脉内抗生素）和专门用于癌症患者的措施（死亡前 14 天内最后一次化疗剂量、死亡前 30 天内开始新的化疗方案、生命最后一个月内至少 1 次急诊就诊、生命最后一个月内至少 1 次住院或住院 14 天以上、急性护理医院死亡）。
所有 COC 评分均与 IEOL 的发生呈负相关，年龄较大、家庭护理利用和门诊医生密度也是如此。对于 COC 指数，比值比为 0.55（95%置信区间为 0.37-0.83）。
COC 评分与 IEOL 呈一致的负相关。该研究支持努力改善癌症患者生命末期的 COC。
