PDF(Pubmed)
Abstract：
BACKGROUND: The effectiveness of generalist palliative care interventions in hospitals is unknown.
OBJECTIVE: This study aimed to explore the impact of a palliative care case management intervention for patients with gastrointestinal cancer (PalMaGiC) on hospital admissions, healthcare use, and place of death.
METHODS: This was a register-based cohort study analyzing data from the Danish Register on Causes of Death, the Danish National Patient Register, and the Danish Palliative Database.
METHODS: Deceased patients with gastrointestinal cancer from 2010 to 2020 exposed to PalMaGiC were compared over three periods of time to patients receiving standard care.
RESULTS: A total of 43,969 patients with gastrointestinal cancers were included in the study, of whom 1518 were exposed to PalMaGiC. In the last 30 days of life, exposed patients were significantly more likely to be hospitalized (OR of 1.62 (95% CI 1.26-2.01)), spend more days at the hospital, estimate of 1.21 (95% CI 1.02-1.44), and have a higher number of hospital admissions (RR of 1.13 (95% CI 1.01-1.27)), and were more likely to die at the hospital (OR of 1.94 (95% CI 1.55-2.44)) with an increasing trend over time. No differences were found for hospital healthcare use.
CONCLUSIONS: Patients exposed to the PalMaGiC intervention had a greater likelihood of hospitalizations and death at the hospital compared to unexposed patients, despite the opposite intention. Sensitivity analyses show that regional differences may hold some of the explanation for this. Future development of generalist palliative care in hospitals should focus on integrating a home-based approach, community care, and PC physician involvement.
OBJECTIVE: This study aimed to explore the impact of a palliative care case management intervention for patients with gastrointestinal cancer (PalMaGiC) on hospital admissions, healthcare use, and place of death.
METHODS: This was a register-based cohort study analyzing data from the Danish Register on Causes of Death, the Danish National Patient Register, and the Danish Palliative Database.
METHODS: Deceased patients with gastrointestinal cancer from 2010 to 2020 exposed to PalMaGiC were compared over three periods of time to patients receiving standard care.
RESULTS: A total of 43,969 patients with gastrointestinal cancers were included in the study, of whom 1518 were exposed to PalMaGiC. In the last 30 days of life, exposed patients were significantly more likely to be hospitalized (OR of 1.62 (95% CI 1.26-2.01)), spend more days at the hospital, estimate of 1.21 (95% CI 1.02-1.44), and have a higher number of hospital admissions (RR of 1.13 (95% CI 1.01-1.27)), and were more likely to die at the hospital (OR of 1.94 (95% CI 1.55-2.44)) with an increasing trend over time. No differences were found for hospital healthcare use.
CONCLUSIONS: Patients exposed to the PalMaGiC intervention had a greater likelihood of hospitalizations and death at the hospital compared to unexposed patients, despite the opposite intention. Sensitivity analyses show that regional differences may hold some of the explanation for this. Future development of generalist palliative care in hospitals should focus on integrating a home-based approach, community care, and PC physician involvement.
摘要：
背景：一般姑息治疗干预措施在医院的有效性尚不清楚。
目的：本研究旨在探讨姑息治疗病例管理干预对胃肠道肿瘤患者（PalMaGiC）入院的影响。医疗保健使用,和死亡的地方。
方法：这是一项基于注册的队列研究，分析来自丹麦死亡原因注册的数据，丹麦国家患者登记册,和丹麦姑息数据库。
方法：将2010年至2020年期间接受PalMaGiC治疗的胃肠道癌症患者与接受标准治疗的患者进行了三个时间段的比较。
结果：共有43,969例胃肠道癌症患者被纳入研究，其中1518人接触过PalMaGiC。在生命的最后30天，暴露患者住院的可能性显着增加（OR为1.62（95％CI1.26-2.01）），在医院待更多的日子,估计为1.21（95%CI1.02-1.44），住院人数较高(RR为1.13(95%CI1.01-1.27))，并且更有可能在医院死亡（OR为1.94（95％CI1.55-2.44）），并且随着时间的推移呈上升趋势。在医院医疗保健使用中没有发现差异。
结论：与未接触患者相比，接受PalMaGiC干预的患者住院和死亡的可能性更大，尽管有相反的意图。敏感性分析表明，区域差异可能对此有一些解释。未来医院的通识姑息治疗的发展应侧重于整合家庭为基础的方法，社区护理,和PC医生参与。
目的：本研究旨在探讨姑息治疗病例管理干预对胃肠道肿瘤患者（PalMaGiC）入院的影响。医疗保健使用,和死亡的地方。
方法：这是一项基于注册的队列研究，分析来自丹麦死亡原因注册的数据，丹麦国家患者登记册,和丹麦姑息数据库。
方法：将2010年至2020年期间接受PalMaGiC治疗的胃肠道癌症患者与接受标准治疗的患者进行了三个时间段的比较。
结果：共有43,969例胃肠道癌症患者被纳入研究，其中1518人接触过PalMaGiC。在生命的最后30天，暴露患者住院的可能性显着增加（OR为1.62（95％CI1.26-2.01）），在医院待更多的日子,估计为1.21（95%CI1.02-1.44），住院人数较高(RR为1.13(95%CI1.01-1.27))，并且更有可能在医院死亡（OR为1.94（95％CI1.55-2.44）），并且随着时间的推移呈上升趋势。在医院医疗保健使用中没有发现差异。
结论：与未接触患者相比，接受PalMaGiC干预的患者住院和死亡的可能性更大，尽管有相反的意图。敏感性分析表明，区域差异可能对此有一些解释。未来医院的通识姑息治疗的发展应侧重于整合家庭为基础的方法，社区护理,和PC医生参与。
