在退伍军人卫生管理局中,COPD的息和临终关怀的时间趋势,设置和时间,2010-2020年
Natalia Smirnova1, Sarah H Cross1, Jordan A Kempker1
1Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine (N. Smirnova and J. A. K.) and the Division of Palliative Medicine, Department of Family and Preventive Medicine (S. H. C. and D. K.), Emory University, Atlanta, GA; the Division of Pulmonary, Allergy and Critical Care Medicine (D. R. S.), Oregon Health and Science University, Portland, OR; the Center to Improve Veteran Involvement in their Care (CIVIC) (D. R. S.), VA Portland Health Care System, Portland, OR; the Knight Cancer Institute (D. R. S.), Oregon Health and Science University, Portland, OR; The College of Nursing (L. F. R.), University of Utah, Salt Lake City, UT; the Department of Respiratory and Sleep Medicine (N. Smallwood), Alfred Hospital, Prahran, VIC, Australia; the School of Translational Medicine (N. Smallwood), Monash University, Melbourne, VIC, Australia; the Center of Innovation for Veteran-Centered and Value-Driven Care (R. P. and D. A.), Veterans Affairs Puget Sound Health Care System, Seattle, WA; the Division of Respiratory Medicine (K. D.), Department of Medicine, University of British Columbia, Vancouver, BC, Canada; the School of Nursing (S. L. F.), Yale University, New Haven, CT; the Department of Veterans Affairs (S. L. F.), West Haven, CT; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health (Y. M.) and the Division of Geriatrics and Gerontology, Department of Medicine (C. V.), Emory University, Atlanta, GA; the Department of Veterans Affairs Birmingham/Atlanta Geriatric Research Education and Clinical Center (C. V.), Atlanta, GA; and the Division of Pulmonary, Critical Care, and Sleep Medicine (D. A.), University of Washington, Seattle, WA.
大多数患有慢性阻塞性肺病 (COPD) 的退伍军人没有得到及时的息治疗,尽管十年来使用量增加了. 需要有针对性的策略来改善这些患者获得息和临终关怀服务的机会.
科学领域:
- 肺部医学 肺部医学
- 老年病的医生 老年病的医生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 慢性阻塞性肺病 (COPD) 由于身体,心理和医疗负担,严重影响患者的生活质量.
- 早期的专业息护理对于减轻COPD患者的这些负担至关重要.
研究的目的:
- 在被诊断患有COPD的已故退伍军人中确定与息治疗利用相关的因素.
- 分析COPD患者在生命最后一年接受息治疗的趋势和时间.
主要方法:
- 一项全国性回顾性队列研究使用了2010年至2020年间死亡的COPD退伍军人的数据.
- 混合效应的多变量回归模型评估了与接受息治疗相关的患者特征.
- 二次结局包括退伍军人事务局的住院治疗,息治疗时间和使用趋势.
主要成果:
- 在332770名COPD患者中,只有16.8%的患者在死亡的一年内接受了息治疗,通常是在住院治疗的环境中.
- 与缓解护理使用增加相关的因素包括肺癌和充血性心力衰竭,体重不足,住房不稳定,黑人或西班牙裔等并发症.
- 已婚患者和农村机构的患者接受息治疗的可能性较低,在研究期间从10.4%增加到16.0%.
结论:
- 尽管息治疗的使用量有所增加,但大多数患有COPD的退伍军人在过去的一年中没有获得这些服务或退伍军人事务住院临终关怀.
- 息治疗经常在疾病发展轨迹的晚期开始.
- 迫切需要加强战略,以改善COPD患者的临床治疗和临终关怀的准入和及时提供.
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