重症の入院患者に対するデフォルトの緩和医療相談: プラグマティック・クラスター・ランダム化試験
Katherine R Courtright1,2,3,4, Vanessa Madden2, Brian Bayes2
1Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia.
JAMA
|January 16, 2024
まとめ
重症の入院患者に対する 緩和医療の標準診療の実施は 診療率を高め,終末期ケアプロセスを改善したが,入院期間を短縮することはなかった.
科学分野:
- 緩和医療
- 医療サービス研究
- 高齢者医療
背景:
- 緩和医療の提供は 病院に収容された患者にとって 優先されるようになりました
- 定期的な緩和医療の有効性に関する大規模な証拠は限られている.
- 重症患者の緩和医療へのアクセスを最適化することは,医療の重要な目標です.
研究 の 目的:
- 病院で治療を受ける資格のある患者に 緩和医療の相談を自動的に依頼する効果を評価する.
- この標準的なアプローチで 人員を増やすことなく 成果が向上するかどうかを判断する.
- 診察率,滞在期間,終末期ケアへの影響を評価する.
主な方法:
- 11の病院で 実践的で 段階的なクラスターランダム化試験を行いました
- 進行慢性閉塞性肺疾患,認知症,または腎不全を有する65歳以上の患者を含む.
- 既定の緩和ケア命令と通常のケア (臨床医による命令) の比較
主要な成果:
- デフォルトの注文は,緩和ケアへの相談率 (43. 9% vs 16. 6%) を大幅に増加させ,タイミングを速めた.
- グループ間の入院期間には大きな違いはなかった.
- 精神病院への退院の割合が 増加しました
結論:
- 控えめな緩和ケアでの診察は 診察の頻度とタイミングを高めます
- このアプローチは重症患者の終末期ケアプロセスを改善します
- 既定の注文は入院期間を短縮したのではなく 介護の調整を改善した.
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