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背景疗养院认知和功能受损者生命中最后几个月的医疗保健过渡是一项负担较重的工作,且临床获益有限。方法为调查过世前120 d居住在疗养院且存在认知和功能受损者的医疗保健过渡情况,收集了来自全国范围的源于医疗保健的最小数据集,要求时间为2000—2007年。过渡困难类型定义为在生命的最后90 d内,住院治疗后缺乏连续的疗养院看护,或在生命的最后90 d内多次住院治疗。我们也考虑到了过渡时期困难率变化的各种因素。调查了区域性的过渡困难率与进行鼻饲、生命最后1个月的ICU住院治疗、Ⅳ级压疮及生命最后3 d进入临终关怀医院的关系。结果疗养院474 829例死者中有19.0%至少发生过1次过渡困难(阿拉斯加州的2.1%～路易斯安那州的37.5%)。校正分析显示,黑人、西班牙人和无管理照护者的死亡风险增加。与那些过渡困难最低五分位数者相比,位于最高五分位数的疗养院居民更有可能进行鼻饲(校正RR=38)、临终前1个月住ICU(校正RR=2.10)、有IV级压疮(校正RR=2.28)或进入临终关怀医院(校正RR=1.17)。结论过渡困难是常见的,但各州发生率有所不同,与生命末期的不良保健相关。
Background The health care transition in the last months of life in persons with cognitive and functional impairments in nursing homes is a more burdensome exercise with limited clinical benefit. Methods To investigate the transition of health care living in nursing homes with impaired cognitive and functional functioning 120 days prior to death, a minimum national data-collection set from health care was collected from 2000-2007. The type of transitional difficulty is defined as the lack of continuous nursing home care after hospitalization or multiple hospitalizations during the last 90 days of life within the last 90 days of life. We have also taken into account the various factors that have contributed to the change in the difficulty rate during the transition period. Investigated the relationship between regional transitional difficulty rates and nasal feeding, ICU hospitalization in the last month of life, grade IV pressure ulcers and the last 3 days of life into hospice hospitals. As a result, 19.0% of the 474 829 dead in nursing homes experienced at least one transitional difficulty (2.1% in Alaska ~ 37.5% in Louisiana). Correctional analysis revealed an increased risk of death among blacks, Hispanics and unmanaged caregivers. Sanitarium residents in the highest quintile were more likely to have nasal feeding (RR = 38 adjusted) compared with those with the lowest quintile of transitional difficulties, ICU (RR = 2.10) one month prior to dying, and IV Grade pressure sore (RR = 2.28) or to Hospice (RR = 1.17). Conclusions Transition difficulties are common, but the incidence varies by state and is associated with poor health care at the end of life.