Effect of hospice care on quality indicators of end-of-life care among patients with liver cancer: a national longitudinal population-based study in Taiwan 2000–2011Reportar como inadecuado




Effect of hospice care on quality indicators of end-of-life care among patients with liver cancer: a national longitudinal population-based study in Taiwan 2000–2011 - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Palliative Care

, 14:39

First Online: 19 August 2015Received: 15 March 2015Accepted: 11 August 2015

Abstract

BackgroundQuality of near end-of-life EOL care is typically evaluated using six accepted quality indicators QIs. Research has yet to evaluate the quality of EOL care for liver cancer patients in Taiwan. We evaluated the effect of hospice care on the quality of EOL care for patients with advanced liver cancer.

MethodsUsing claims data obtained from the Taiwan National Health Insurance Research Database, we analyzed the QIs of EOL care for patients who died between 2000 and 2011. Logistic regression was performed to identify predictors for QIs of EOL care.

ResultsA total of 3092 adult patients died of liver cancer during the study period. The patients were divided into those who received hospice care for a period longer than 1 month long-H group, shorter than 1 month short-H group, and not at all non-H group. There was no significant difference in survival probability among the three groups p = 0.212. Compared with the non-H group, the long- and short-H groups exhibited a significantly lower risk of being admitted to an intensive care unit ICU odds ratios ORs = 0.25 and 0.26, respectively, p < 0.001 and requiring cardiopulmonary resuscitation CPR during the final month of life ORs = 0.21 and 0.09, respectively, p < 0.001. Compared with the non-H group, the short-H group had a higher risk of more than one emergency room ER visit, and more than one hospital admission OR = 1.97, p = 0.003; and OR = 1.56, p = 0.001, respectively, but the long-H group did not differed significantly from the non-H group on these measures.

ConclusionsPatients with liver cancer who received hospice care were less likely to be admitted to ICUs or require CPR compared with those who received no hospice care. A longer duration of hospice care was associated with reduced risks of more than one ER visit and more than one hospital admission. We conclude that EOL cancer care in Taiwan might be improved by implementing policies encouraging early hospice referral programs.

AbbreviationsAUCarea under the receiver operating characteristic curve

CCICharlson comorbidity index

CICcatastrophic illness certificate

CKDchronic kidney disease

CPRcardiopulmonary resuscitation

DNRDo not resuscitate

EOLend-of-life

ERemergency room

HAIChepatic arterial infusion chemotherapy

HBVhepatitis B virus

HCVhepatitis C virus

ICD-9-CMInternational Classification of Diseases, Ninth Revision, Clinical Modification

ICUintensive care unit

NHINational Health Insurance

NHIRDNational Health Insurance Research Database

PEIpercutaneous ethanol injection

QIquality indicator

RFAradiofrequency ablation

SESsocioeconomic status

TACEtransarterial chemoembolization

Electronic supplementary materialThe online version of this article doi:10.1186-s12904-015-0036-9 contains supplementary material, which is available to authorized users.

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Autor: Yee-Hsin Kao - Jui-Kun Chiang

Fuente: https://link.springer.com/



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