Background: Information on the use of palliative care and aggressive treatments for terminally ill patients who receive care from hospitalists is limited. Methods: This three-year, retrospective, case-control study was conducted at an academic medical center in Taiwan. Among 7037 patients who died in the hospital, 41.7% had a primary diagnosis of cancer. A total of 815 deceased patients who received hospitalist care before death were compared with 3260 patients who received non-hospitalist care after matching for age, gender, catastrophic illness, and Charlson comorbidity score. Regression models with generalized estimating equations were performed. Results: Patients who received hospitalist care before death, compared to those who did not, had a higher probability of palliative care consultation (odds ratio (OR) = 3.41, 95% confidence interval (CI): 2.63–4.41), and a lower probability to undergo invasive mechanical ventilation (OR = 0.13, 95% CI: 0.10–0.17), tracheostomy (OR = 0.14, 95% CI: 0.06–0.31), hemodialysis (OR = 0.70, 95% CI: 0.55–0.89), surgery (OR = 0.25, 95% CI: 0.19–0.31), and intensive care unit admission (OR = 0.11, 95% CI: 0.08–0.14). Hospitalist care was associated with reductions in length of stay (coefficient (B) = −0.54, 95% CI: −0.62–−0.46) and daily medical costs. Conclusions: Hospitalist care is associated with an improved palliative consultation rate and reduced life-sustaining treatments before death.
背景：关于由住院医师照护的终末期患者使用缓和医疗及积极治疗的信息有限。方法：这项为期三年的回顾性病例对照研究在台湾某学术医疗中心进行。在7037名院内死亡患者中，41.7%以癌症为主要诊断。通过匹配年龄、性别、重大伤病及查尔森共病指数，将815名生前接受住院医师照护的死亡患者与3260名接受非住院医师照护的患者进行比较。采用广义估计方程回归模型进行分析。结果：与未接受住院医师照护的患者相比，生前接受住院医师照护的患者获得缓和医疗会诊的概率更高（比值比（OR）= 3.41，95%置信区间（CI）：2.63–4.41），而接受有创机械通气（OR = 0.13，95% CI：0.10–0.17）、气管切开术（OR = 0.14，95% CI：0.06–0.31）、血液透析（OR = 0.70，95% CI：0.55–0.89）、手术（OR = 0.25，95% CI：0.19–0.31）及入住重症监护室（OR = 0.11，95% CI：0.08–0.14）的概率更低。住院医师照护与住院时间的缩短（系数（B）= −0.54，95% CI：−0.62–−0.46）及日均医疗费用的降低相关。结论：住院医师照护与临终前缓和医疗会诊率的提升及生命维持治疗的减少具有相关性。
肿瘤(癌症)患者之家