养老院居民与社区居民的初级和专科姑息家庭护理的利用情况及质量：一项索赔数据分析。
Utilization and quality of primary and specialized palliative homecare in nursing home residents vs. community dwellers: a claims data analysis.
作者信息
Poeck Juliane, Meissner Franziska, Ditscheid Bianka, Krause Markus, Wedding Ulrich, Gebel Cordula, Marschall Ursula, Meyer Gabriele, Schneider Werner, Freytag Antje
机构信息
Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany.
Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany.
出版信息
BMC Palliat Care. 2025 Jan 7;24(1):3. doi: 10.1186/s12904-024-01631-z.
BACKGROUND
There are hardly any data on the extent to which nursing home residents are provided with palliative homecare. We want to add evidence by comparing nursing home residents (who had been living in a nursing home for at least one year) and nursing-care-dependent community dwellers in terms of utilization and quality of palliative homecare.
METHODS
We conducted a population-based study with nationwide claims data from deceased beneficiaries of a large German health insurance provider. First, we compared utilization rates of primary palliative care [PPC], specialized palliative homecare [SPHC], and no palliative care [noPC] between nursing home residents and community dwellers, both descriptively and adjusted for covariates. Second, we analyzed the (adjusted) relationship between PPC-only and SPHC (both: starting ≥ 30 days before death), and noPC with healthcare indicators (death in hospital, hospitalization, emergencies, intensive care treatment within the last 30 days of life), and compared these relationships between nursing home residents and community dwellers. Analyses were conducted using simple and multiple logistic regression. Data were standardized by age and gender.
RESULTS
From 117,436 decedents in 2019, 71,803 could be included in the first, 55,367 in the second analysis. The rate of decedents with noPC was higher in nursing home residents (61.3%) compared to community dwellers (56.6%). Nursing home residents received less SPHC (10.7% vs. 23.2%) but more PPC (30.3% vs. 27.0%) than community dwellers, and achieved better outcomes across all end-of-life healthcare indicators. Adjusted for covariates, both types of palliative homecare were associated with beneficial outcomes, in nursing home residents as well as in community dwellers, with generally better outcomes for SPHC than PPC-only. For most outcomes, the associations with palliative homecare were equal or smaller in nursing home residents than in community dwellers.
CONCLUSIONS
The overall better performance in quality of end-of-life care in nursing home residents than in community dwellers may be due to the institutionally provided nursing and general practitioner care within nursing homes. This may also explain higher rates of PPC and lower rates of SPHC in nursing home residents, and why the relationship with both PPC and SPHC are smaller in nursing home residents.
TRIAL REGISTRATION
German Clinical Trials Register (DRKS): [DRKS00024133, Date of registration: 28.06.2021].
背景
关于养老院居民接受姑息性家庭护理的程度，几乎没有相关数据。我们希望通过比较养老院居民（在养老院居住至少一年）和需要护理的社区居民在姑息性家庭护理的利用率和质量方面的情况来补充证据。
方法
我们利用一家大型德国健康保险公司已故受益人的全国性理赔数据进行了一项基于人群的研究。首先，我们描述性地并针对协变量进行调整后，比较了养老院居民和社区居民之间的初级姑息治疗[PPC]、专门的姑息性家庭护理[SPHC]和未接受姑息治疗[noPC]的利用率。其次，我们分析了仅接受PPC和SPHC（均在死亡前≥30天开始）与noPC和医疗保健指标（在医院死亡、住院、急诊、生命最后30天内的重症监护治疗）之间的（调整后）关系，并比较了养老院居民和社区居民之间的这些关系。分析采用简单和多元逻辑回归进行。数据按年龄和性别进行了标准化。
结果
在2019年的117436名死者中，71803名可纳入第一次分析,55367名可纳入第二次分析。与社区居民（56.6%）相比，养老院居民中未接受姑息治疗的死者比例更高（61.3%）。与社区居民相比，养老院居民接受的SPHC较少（10.7%对23.2%），但接受PPC较多（30.3%对27.0%），并且在所有临终医疗保健指标方面都取得了更好的结果。针对协变量进行调整后，两种类型的姑息性家庭护理在养老院居民和社区居民中均与有益结果相关，总体而言，SPHC的结果比仅接受PPC更好。对于大多数结果，养老院居民中与姑息性家庭护理的关联与社区居民相比相同或更小。
结论
养老院居民在临终护理质量方面总体表现优于社区居民，这可能归因于养老院提供的机构护理和全科医生护理。这也可以解释为什么养老院居民中PPC的比例较高而SPHC的比例较低，以及为什么养老院居民中与PPC和SPHC的关联都较小。
试验注册
德国临床试验注册中心（DRKS）：[DRKS00024133，注册日期：2021年6月28日]
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