Dillon Ellis C, Shugrue Noreen, Migneault Deborah, Lee Chae Man, Wakefield Dorothy, Charles Doreek, Richards Bradley, Robison Julie
Center on Aging, UConn Health, Farmington, Connecticut, USA.
Connecticut Department of Social Services, Hartford, Connecticut, USA.
J Palliat Med. 2025 Mar;28(3):365-370. doi: 10.1089/jpm.2024.0244. Epub 2024 Dec 5.
The relationship between nursing home (NH) stays before death and hospice use is understudied. A retrospective cohort study of Connecticut Medicaid decedents with common hospice diagnoses who died between 2017 and 2020. Medicaid/Medicare claims identified NH stays, hospice use, short length of stay (LOS) (≤7 days), demographics, and diagnoses. Logistic regression models examined associations between NH stays with hospice use and LOS. Among 26,261 decedents, 54.2% had NH stays (17.8% short-term, 36.4% long-term). Individuals with NH stays (vs. none) had reduced odds of hospice use (short-term odds ratio [OR]: 0.77 [95% confidence interval or CI: 0.71-0.82] and long-term OR: 0.47 [0.45-0.50]) and had higher odds of short hospice LOS (short-term OR: 2.67 [2.41-2.96] and long-term OR: 2.95 [2.69-3.22]). Further research is needed into why individuals with NH stays, especially long-term stays, are less likely to use hospice and more likely to have short LOS and how this difference relates to end-of-life care quality.
临终前在养老院的停留时间与临终关怀服务的使用之间的关系尚未得到充分研究。这是一项针对2017年至2020年间死亡的康涅狄格州医疗补助计划死者的回顾性队列研究，这些死者患有常见的临终关怀诊断。医疗补助/医疗保险理赔记录确定了养老院停留时间、临终关怀服务的使用情况、短住院时长（≤7天）、人口统计学特征和诊断信息。逻辑回归模型检验了养老院停留时间与临终关怀服务使用及住院时长之间的关联。在26261名死者中，54.2%曾在养老院停留（17.8%为短期停留，36.4%为长期停留）。有养老院停留经历的个体（与无此经历者相比）接受临终关怀服务的几率降低（短期优势比[OR]：0.77[95%置信区间或CI：0.71 - 0.82]，长期OR：0.47[0.45 - 0.50]），且临终关怀服务短住院时长的几率更高（短期OR：2.67[2.41 - 2.96]，长期OR：2.95[2.69 - 3.22]）。需要进一步研究为何有养老院停留经历的个体，尤其是长期停留者，使用临终关怀服务的可能性较小且住院时长较短，以及这种差异与临终护理质量有何关联。
