Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, USA.
Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Cancer. 2023 Dec 1;129(23):3797-3804. doi: 10.1002/cncr.35008. Epub 2023 Sep 14.
Unplanned hospitalizations among patients with advanced cancer are often sentinel events prompting goals of care discussions and hospice transitions. Late referrals to hospice, especially those at the end of life, are associated with decreased quality of life and higher total health care costs. Inpatient management of patients with solid tumor malignancies is increasingly shifting from oncologists to oncology hospitalists. However, little is known about the impact of oncology hospitalists on the timing of transition to hospice.
To compare hospice discharge rate and time to hospice discharge on an inpatient oncology service led by internal medicine-trained hospitalists and a service led by oncologists.
At Smilow Cancer Hospital, internal medicine-trained hospitalists were integrated into one of two inpatient medical oncology services allowing comparison between the new, hospitalist-led service (HS) and the traditional, oncologist-led service (TS). Discharges from July 26, 2021, through January 31, 2022, were identified from the electronic medical record. The odds ratio for discharge disposition by team was calculated by logistic regression using a multinomial distribution. Adjusted length of stay before discharge was assessed using multivariable linear regression.
The HS discharged 47/400 (11.8%) patients to inpatient hospice, whereas the TS service discharged 18/313 (5.8%), yielding an adjusted odds ratio of 1.94 (95% CI, 1.07-3.51; p = .03). Adjusted average length of stay before inpatient hospice disposition was 6.83 days (95% CI, 4.22-11.06) for the HS and 16.29 days (95% CI, 7.73-34.29) for the TS (p = .003).
Oncology hospitalists improve hospice utilization and time to inpatient hospice referral on an inpatient medical oncology service.
Patients with advanced cancer are often admitted to the hospital near the end of life. These patients generally have a poor chance of long-term survival and may prefer comfort-focused care with hospice. In this study, oncology hospitalists discharged a higher proportion of patients to inpatient hospice with less time spent in the hospital before discharge.
晚期癌症患者的非计划性住院通常是引发医疗照护目标讨论和转介至缓和医疗的重要事件。晚期转介至缓和医疗，尤其是临终前的转介，与生活质量下降和整体医疗保健费用增加有关。实体瘤恶性肿瘤患者的住院管理正逐渐从肿瘤学家转向肿瘤内科住院医师。然而，我们对肿瘤内科住院医师对转介至缓和医疗的时机的影响知之甚少。
比较由内科培训的肿瘤内科住院医师主导的住院肿瘤科服务和由肿瘤学家主导的服务中转介至缓和医疗的出院率和转介至缓和医疗的时间。
在斯米尔诺癌症医院，内科培训的肿瘤内科住院医师被整合到两个住院内科肿瘤学服务之一中，允许比较新的、由住院医师主导的服务（HS）和传统的、由肿瘤学家主导的服务（TS）。从电子病历中确定 2021 年 7 月 26 日至 2022 年 1 月 31 日的出院患者。使用多项分布的逻辑回归计算团队出院处置的优势比。使用多变量线性回归评估出院前的调整住院时间。
HS 将 47/400（11.8%）名患者转介至住院缓和医疗，而 TS 服务仅将 18/313（5.8%）名患者转介至住院缓和医疗，调整后的优势比为 1.94（95%置信区间，1.07-3.51；p=0.03）。HS 调整后的平均住院时间为 6.83 天（95%置信区间，4.22-11.06），而 TS 为 16.29 天（95%置信区间，7.73-34.29）（p=0.003）。
肿瘤内科住院医师改善了住院内科肿瘤学服务中转介至缓和医疗的利用和时间。
晚期癌症患者通常在生命接近尾声时住院。这些患者长期生存的机会通常较差，可能更愿意接受以舒适为中心的关怀，包括缓和医疗。在这项研究中，肿瘤内科住院医师以更高的比例将患者转介至住院缓和医疗，并在出院前减少了在医院的时间。
