کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
2724362 1146144 2013 9 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Enrollment and Events of Hospice Patients With Heart Failure vs. Cancer
موضوعات مرتبط
علوم زیستی و بیوفناوری علم عصب شناسی عصب شناسی
پیش نمایش صفحه اول مقاله
Enrollment and Events of Hospice Patients With Heart Failure vs. Cancer
چکیده انگلیسی

ContextHospice care is traditionally used for patients with advanced cancer, but it is increasingly considered for patients with end-stage heart failure.ObjectivesWe compared enrollment patterns and clinical events of hospice patients with end-stage heart failure with those of patients with advanced cancer.MethodsUsing Medicare data linked with pharmacy and cancer registry data, we identified patients who were diagnosed with either heart failure or advanced cancer between 1997 and 2004, admitted to hospice at least once after their diagnosis, and died during the study period. We compared patterns of referral, use of acute services, and site of death of hospice patients with heart failure with those of patients with advanced cancer. Logistic regression models were constructed to determine the factors associated with late hospice enrollment as well as the use of and death in acute care.ResultsWe identified 1580 heart failure patients and 3840 advanced cancer patients: mean ages were 86 and 80 years, 82% and 68% were women, and 97% and 94% were white, respectively. Compared with patients with advanced cancer, those with heart failure were more frequently referred to hospice from hospitals (35% vs. 24%) and nursing facilities (9% vs. 7%) (both P < 0.01). Discharge from hospice before death was similar for patients with heart failure and patients with advanced cancer (10% vs. 9%, P = 0.03). Among patients remaining in hospice, patients with heart failure were more likely to have been enrolled within three days of death (20% vs.11%, P < 0.01). The prevalence of death in acute care settings was low in both groups after hospice enrollment (4% heart failure vs. 2% advanced cancer, P < 0.01). Although the median interval between enrollment and death was shorter for heart failure patients (12 vs. 20 days, P < 0.001), emergency department visits and hospitalizations after hospice enrollment were more frequent in patients with heart failure (13% vs. 10% and 9% vs. 6%, respectively, both P < 0.01).ConclusionCompared with patients with advanced cancer, referral to hospice is more often initiated during acute care encounters for patients with end-stage heart failure, who also more frequently return to acute care settings even after hospice enrollment.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of Pain and Symptom Management - Volume 45, Issue 3, March 2013, Pages 552–560
نویسندگان
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