Abstract：
BACKGROUND: The benefits of palliative care in patients with advanced cancer are well established. However, the effect of the skills of the palliative care team (PCT) on patient outcomes remains unclear. Our aim was to evaluate the association between hospital PCT intervention volume and patient outcomes in patients with cancer.
METHODS: A retrospective cohort study was conducted using a nationwide inpatient database in Japan. Patients with cancer receiving chemotherapy and PCT intervention from 2015 to 2020 were included. The outcomes were incidence of hyperactive delirium within 30 days of admission, mortality within 30 days of admission, and decline in activities of daily living (ADL) at discharge. The exposure of interest was hospital PCT intervention volume (annual number of new PCT interventions in a hospital), which was categorized into low-, intermediate-, and high-volume groups according to tertiles. Multivariate logistic regression and restricted cubic-spline regression were conducted.
RESULTS: Of 29,076 patients, 1495 (5.1%), 562 (1.9%), and 3026 (10.4%) developed delirium, mortality, and decline in ADL, respectively. Compared with the low hospital PCT intervention volume group (1-103 cases/year, n = 9712), the intermediate (104-195, n = 9664) and high (196-679, n = 9700) volume groups showed significant association with lower odds ratios of 30-day delirium (odds ratio, 0.79 [95% confidence interval, 0.69-0.91] and 0.80 [0.69-0.93], respectively), 30-day mortality (0.73 [0.60-0.90] and 0.59 [0.46-0.75], respectively), and decline in ADL (0.77 [0.70-0.84] and 0.52 [0.47-0.58], respectively).
CONCLUSIONS: Hospital PCT intervention volume is inversely associated with the odds ratios of delirium, mortality, and decline in ADL among hospitalized patients with cancer.
METHODS: A retrospective cohort study was conducted using a nationwide inpatient database in Japan. Patients with cancer receiving chemotherapy and PCT intervention from 2015 to 2020 were included. The outcomes were incidence of hyperactive delirium within 30 days of admission, mortality within 30 days of admission, and decline in activities of daily living (ADL) at discharge. The exposure of interest was hospital PCT intervention volume (annual number of new PCT interventions in a hospital), which was categorized into low-, intermediate-, and high-volume groups according to tertiles. Multivariate logistic regression and restricted cubic-spline regression were conducted.
RESULTS: Of 29,076 patients, 1495 (5.1%), 562 (1.9%), and 3026 (10.4%) developed delirium, mortality, and decline in ADL, respectively. Compared with the low hospital PCT intervention volume group (1-103 cases/year, n = 9712), the intermediate (104-195, n = 9664) and high (196-679, n = 9700) volume groups showed significant association with lower odds ratios of 30-day delirium (odds ratio, 0.79 [95% confidence interval, 0.69-0.91] and 0.80 [0.69-0.93], respectively), 30-day mortality (0.73 [0.60-0.90] and 0.59 [0.46-0.75], respectively), and decline in ADL (0.77 [0.70-0.84] and 0.52 [0.47-0.58], respectively).
CONCLUSIONS: Hospital PCT intervention volume is inversely associated with the odds ratios of delirium, mortality, and decline in ADL among hospitalized patients with cancer.
摘要：
背景：姑息治疗在晚期癌症患者中的益处已经确立。然而,姑息治疗团队(PCT)的技能对患者结局的影响尚不清楚.我们的目的是评估医院PCT干预量与癌症患者预后之间的关系。
方法：使用日本全国住院患者数据库进行了一项回顾性队列研究。纳入2015年至2020年接受化疗和PCT干预的癌症患者。结果是入院后30天内过度活跃的谵妄发生率，入院后30天内的死亡率，出院时日常生活活动(ADL)下降。感兴趣的暴露量是医院PCT干预量（医院新PCT干预措施的年度数量），被归类为低，中介-，和高容量组。进行多因素logistic回归和限制性三次样条回归。
结果：在29,076名患者中，1495（5.1%），562（1.9%），3026人(10.4%)出现谵妄，死亡率,ADL下降，分别。与低住院PCT干预量组(1-103例/年,n=9712),中间（104-195，n=9664）和高（196-679，n=9700）体积组显示出与30天谵妄的低比值比（比值比，0.79[95%置信区间，0.69-0.91]和0.80[0.69-0.93]，分别)，30天死亡率（0.73[0.60-0.90]和0.59[0.46-0.75]，分别)，ADL下降(0.77[0.70-0.84]和0.52[0.47-0.58]，分别)。
结论：医院PCT干预量与谵妄的比值比呈负相关，死亡率,住院癌症患者的ADL下降。
方法：使用日本全国住院患者数据库进行了一项回顾性队列研究。纳入2015年至2020年接受化疗和PCT干预的癌症患者。结果是入院后30天内过度活跃的谵妄发生率，入院后30天内的死亡率，出院时日常生活活动(ADL)下降。感兴趣的暴露量是医院PCT干预量（医院新PCT干预措施的年度数量），被归类为低，中介-，和高容量组。进行多因素logistic回归和限制性三次样条回归。
结果：在29,076名患者中，1495（5.1%），562（1.9%），3026人(10.4%)出现谵妄，死亡率,ADL下降，分别。与低住院PCT干预量组(1-103例/年,n=9712),中间（104-195，n=9664）和高（196-679，n=9700）体积组显示出与30天谵妄的低比值比（比值比，0.79[95%置信区间，0.69-0.91]和0.80[0.69-0.93]，分别)，30天死亡率（0.73[0.60-0.90]和0.59[0.46-0.75]，分别)，ADL下降(0.77[0.70-0.84]和0.52[0.47-0.58]，分别)。
结论：医院PCT干预量与谵妄的比值比呈负相关，死亡率,住院癌症患者的ADL下降。
