PDF(Pubmed)
Abstract：
Although cancer care is often contextualized in terms of survival, there are other important cancer care outcomes, such as quality of life and cost of care. The ASCO Value Framework assesses the value of cancer therapies not only in terms of survival but also with consideration of quality of life and financial cost. Early palliative care for patients with advanced cancer is associated with improved quality of life, mood, symptoms, and overall survival for patients, as well as cost savings. While palliative care has been shown to have numerous benefits, the impact of real-world implementation of outpatient embedded palliative care on value-based metrics is not fully understood. We sought to describe the association between outpatient embedded palliative care in a multidisciplinary thoracic oncology clinic and inpatient value-based metrics. We performed a retrospective cohort study of 215 patients being treated for advanced thoracic malignancies with non-curative intent. We evaluated the association between outpatient embedded palliative care and inpatient clinical outcomes including emergency room visits, hospitalizations, intensive care unit admissions, hospital charges, as well as hospital quality metrics including 30-day readmissions, admissions within 30 days of death, inpatient mortality, and inpatient hospital charges. Outpatient embedded palliative care was associated with lower hospital charges per day (USD 3807 vs. USD 4695, p = 0.024). Furthermore, patients who received outpatient embedded palliative care had lower hospital admissions within 30 days of death (O.R. 0.45; 95% CI 0.29, 0.68; p < 0.001) and a lower inpatient mortality rate (IRR 0.67; 95% CI 0.48, 0.95; p = 0.024). Our study further supports that outpatient palliative care is a high-value intervention and alternative models of palliative care, including one embedded into a multidisciplinary thoracic oncology clinic, is associated with improved value-based metrics.
摘要：
尽管癌症护理通常是根据生存情况而定的，还有其他重要的癌症护理结果，比如生活质量和护理费用。ASCO价值框架不仅在生存方面，而且在考虑生活质量和财务成本的情况下评估癌症治疗的价值。晚期癌症患者的早期姑息治疗与生活质量的提高有关。心情,症状,以及患者的总体生存率，以及节省成本。虽然姑息治疗已被证明有许多好处，实际实施门诊嵌入式姑息治疗对基于价值的指标的影响尚未完全了解.我们试图描述多学科胸部肿瘤诊所的门诊嵌入式姑息治疗与基于住院价值的指标之间的关联。我们对215例非治愈性晚期胸部恶性肿瘤患者进行了回顾性队列研究。我们评估了门诊嵌入式姑息治疗与住院临床结果（包括急诊室就诊）之间的关联，住院治疗,重症监护室入院，医院收费,以及包括30天再入院在内的医院质量指标，死亡后30天内入院，住院死亡率，和住院费用。门诊嵌入式姑息治疗与每日住院费用较低相关(3807美元vs.4695美元，p=0.024)。此外，接受门诊嵌入式姑息治疗的患者在死亡后30天内住院率较低(O.R.0.45;95%CI0.29,0.68;p<0.001),住院死亡率较低(IRR0.67;95%CI0.48,0.95;p=0.024).我们的研究进一步支持门诊姑息治疗是姑息治疗的高价值干预和替代模式，包括一个嵌入多学科胸部肿瘤诊所的，与改进的基于价值的度量相关联。
