摘要
背景：在台湾，随着人口老龄化的加剧，姑息关怀服务（PCS）已大幅扩展到包括危重病人的综合福利计划，并得到国民健康保险计划的报销支持。然而，将姑息关怀纳入这些病人的医疗管理中面临着一些挑战。我们的目的是评估姑息关怀干预对生命末期医疗资源的影响，以促进姑息关怀的早期使用，并为患者提供高质量的医疗服务：本研究共纳入 2202 名患者。方法：本研究共纳入 2202 名患者，使用 ICD-10 和 HNI 编码评估 PCS 的主要诊断和转诊情况。所有研究对象分为三组：未接受 PCS 的患者（无 PCS）、在最终入院前接受 PCS 的患者（PCS-before）和在最终入院后接受 PCS 的患者（PCS-after）。我们评估了 (i) PCS 对死亡前 30 天内八种医疗资源利用结果的影响，以及 (ii) 早期干预对两种主要疾病的影响：结果：在患者最后一次入院前启动 PCS 与死亡前 30 天内较少的积极医疗干预有关，包括缩短重症监护室 (ICU) 的时间[比值比 (OR) = 0.25]、气管插管率 (OR = 0.12)、呼吸机支持率 (OR = 0.20)、心肺复苏率 (OR = 0.18) 和输血率 (OR = 0.65)。在癌症和肺部疾病患者中，在最终住院超过 14 天之前接受 PCS 治疗的患者住院时间缩短（OR = 0.52 和 0.24）。肺部疾病患者入住重症监护室（OR = 0.44）和呼吸通气（OR = 0.33）的几率也明显降低：结论：姑息治疗干预的时机对住院时间和重症监护病房的停留时间以及插管程序或心肺复苏的需求有着至关重要的影响。研究结果有助于政府和医疗服务提供者制定全面的姑息关怀政策和项目，以提高关怀质量和患者权益。Background: In Taiwan, as the population ages, palliative care services (PCS) have expanded significantly to include comprehensive benefit plans for critically ill individuals, supported by reimbursements from the National Health Insurance program. However, incorporating palliative care into the medical management of these patients presents several challenges. We aim to evaluate the effects of palliative care interventions on medical resources in end-of-life scenarios, to promote earlier palliative care access and provide high-quality healthcare services for patients.
Methods: A total of 2202 patients were included in this study. Primary diagnosis and referral for PCS were assessed using ICD-10 and HNI code. All study subjects were divided into three groups: patients who did not receive PCS (no-PCS), patients who received PCS before their final hospital admission (PCS-before), and patients who received PCS after their final admission (PCS-after). We evaluated (i) the effects of PCS on eight medical resource utilization outcomes within the 30 days preceding death and (ii) the effects of early intervention on two major diseases.
Results: Initiating PCS before a patient's last hospital admission was associated with less aggressive medical interventions in the 30 days before death, including reduced length of intensive care unit (ICU) [odds ratio (OR) = 0.25], and rates of endotracheal intubation (OR = 0.12), respiratory ventilator support (OR = 0.20), cardiopulmonary resuscitation (OR = 0.18), and blood transfusion (OR = 0.65). Among patients with cancer and lung diseases, those who received PCS prior to their final hospitalization of over 14 days experienced reduced hospitalization duration (OR = 0.52 and 0.24, respectively). Patients with lung disease also had significantly lower odds of ICU stays (OR = 0.44) and respiratory ventilation (OR = 0.33).
Conclusion: The timing of palliative care intervention critically impacts on duration of hospitalization and ICU stay and the need for intubation procedures or cardiopulmonary resuscitation. The findings can help the government and medical providers in developing comprehensive palliative care policies and programs to improve care quality and patient rights.
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