医疗保险临终关怀医疗保健局部覆盖范围的准确性 终末期脏疾病的指导方针
Abgail E Lewis1,2, Randi E Foraker3, Patrick White4
1Division of Computational and Data Sciences, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA.
Journal of palliative medicine
|November 28, 2025
概括
对于末期脏疾病 (ESKD) 的医疗保险临终关怀资格准则可能不准确. 大多数患者在死亡前不到六个月就符合标准,这表明ESKD患者的临终关怀机会存在问题.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 抚慰性护理是一种缓解性护理.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 患有末期病 (ESKD) 的患者在美国遇到实质性障碍,无法获得临终关怀.
- 医疗保险局部覆盖确定 (LCD) 准则用于确定临终关怀的资格,表面上是对于预后为六个月的患者.
- 这些LCD指南对于ESKD患者的准确性尚不清楚.
研究的目的:
- 评估医疗保险LCD指南在识别末期病患者的准确性,预后为6个月.
- 确定当前的临终关怀资格标准是否适当地反映了ESKD患者的预期寿命.
主要方法:
- 使用来自中西部问责护理组织的医疗保险受益者数据的回顾性队列研究 (2017年10月 - 2024年5月).
- 包括患有慢性病的已故患者,他们符合ESKD LCD指导方针,并在死亡后180天内进行实验室检测.
- 使用非参数最大概率生存分析来评估在死亡前满足LCD指南的时间.
主要成果:
- 在死亡时符合ESKD LCD指南的769名患者中,只有5%的人至少在六个月前达到标准.
- 至少一个月满足指南的概率为28%.
- 患者满足ESKD LCD指南的中位时间是死亡前9天.
结论:
- 目前的临床医院LCD指南似乎不准确地预测了ESKD患者的六个月预期寿命.
- 这些指导方针可能不适合在ESKD人群中确定宿舍资格.
- 需要进一步的研究来完善慢性病患者的临终关怀准入标准.
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