背景:许多研究表明,癌症患者的临终关怀姑息治疗干预措施可以降低医疗保健的实用性。在台湾,需要机械通气的患者中有20-25%使用长期机械通气(PMV);然而,只有有限数量的研究探讨了临终关怀姑息治疗对这些患者的有效性.这项研究调查了临终关怀姑息治疗对使用PMV的受试者医疗利用的影响。
方法:通过使用全国人群研究的健康保险数据库,我们确定了机械通气时间>21d的受试者,在2009年至2017年期间,年龄≥18岁,并接受了临终关怀姑息治疗。对照组在排除参加姑息治疗<15d或>181d的患者后,通过倾向评分进行1:1匹配。我们使用条件logistic回归分析来调查ICU入院的发生率,急诊科介绍,并在死亡前14d内进行心肺复苏。
结果:2009年至2017年期间,共有186,533名新受试者接受年龄≥18岁的PMV。此外,接受姑息治疗的受试者数量逐年增加,从2009年的0.6%上升到2017年的41.33%。急诊科就诊(比值比[OR]0.68,95%CI0.63-0.74),ICU入院(OR0.59,95%CI0.53-0.66),心肺复苏(OR0.40,95%CI0.35-0.46),和总住院费用($1,319.91±$1,821.66与$1,544.37±$2,309.27[$USD],P<.001)在姑息治疗组中显著较低。
结论:在接受临终关怀姑息治疗的同时接受PMV的受试者的总住院费用显着降低,ICU入院,心肺复苏,和死亡前14天内的医疗费用。
BACKGROUND: Numerous studies have demonstrated that hospice palliative care interventions for cancer patients can reduce health care utilzation. In Taiwan, 20-25% of patients who require mechanical ventilation are using prolonged mechanical ventilation (PMV); however, only a limited number of studies have addressed the effectiveness of hospice palliative care for these patients. This
study investigated the impact of hospice palliative care utilization on medical utilization among subjects using PMV.
METHODS: By using the health insurance database of a nationwide population-based
study, we identified subjects who had been on mechanical ventilation for > 21 d, were age ≥18 y between 2009 and 2017, and had received hospice palliative care. The control group was formed through 1:1 matching by using propensity scoring after excluding patients who had participated in palliative care for <15 d or for >181 d. Furthermore, we used a conditional logistic regression analysis to investigate the incidence of ICU admission, emergency department presentation, and cardiopulmonary resuscitation within 14 d before death.
RESULTS: A total of 186,533 new subjects receiving PMV age ≥ 18 y were admitted between 2009 and 2017. In addition, the number of subjects receiving palliative care increased annually, rising from 0.6% in 2009 to 41.33% in 2017. The emergency department visits (odds ratio [OR] 0.68, 95% CI 0.63-0.74), ICU admission (OR 0.59, 95% CI 0.53-0.66), cardiopulmonary resuscitation (OR 0.40, 95% CI 0.35-0.46), and total hospitalization cost ($1,319.91 ± $1,821.66 versus $1,544.37 ± $2,309.27 [$USD], P < .001) were significant lower in the palliative care group.
CONCLUSIONS: Subjects undergoing PMV while receiving hospice palliative care experienced significant reductions in total hospitalization costs, ICU admissions, cardiopulmonary resuscitation, and medical expenses within 14 d before death.