维持性透析肾衰竭患者的临终关怀:一项基于人群的回顾性研究。

IF 1.6 Q3 UROLOGY & NEPHROLOGY Canadian Journal of Kidney Health and Disease Pub Date : 2024-09-21 eCollection Date: 2024-01-01 DOI:10.1177/20543581241280698
Shuaib Hafid, Sarina R Isenberg, Aleisha Fernandes, Erin Gallagher, Colleen Webber, Meera Joseph, Manish M Sood, Adrianna Bruni, Janet L Davis, Grace Warmels, James Downar, Anastasia Gayowsky, Aaron Jones, Doug Manuel, Peter Tanuseputro, Michelle Howard
{"title":"维持性透析肾衰竭患者的临终关怀:一项基于人群的回顾性研究。","authors":"Shuaib Hafid, Sarina R Isenberg, Aleisha Fernandes, Erin Gallagher, Colleen Webber, Meera Joseph, Manish M Sood, Adrianna Bruni, Janet L Davis, Grace Warmels, James Downar, Anastasia Gayowsky, Aaron Jones, Doug Manuel, Peter Tanuseputro, Michelle Howard","doi":"10.1177/20543581241280698","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Nephrologists routinely provide end-of-life care for patients with kidney failure (KF) on maintenance dialysis. Involvement of primary care and palliative care physicians may enhance this experience.</p><p><strong>Objective: </strong>The objective was to describe outpatient care patterns in the last year of life and the end-of-life acute care utilization for patients with KF on maintenance dialysis.</p><p><strong>Design: </strong>Retrospective cohort study using population-level health administrative data.</p><p><strong>Setting & participants: </strong>Outpatient and inpatient care during the last year of life among patients who died between 2017 and 2019, receiving maintenance dialysis in Ontario, Canada.</p><p><strong>Measurements: </strong>The primary exposure is patterns of physician specialties providing outpatient care in the last year of life. Outcomes include outpatient encounters in the last year of life, acute care visitation in the last month of life, and place of death.</p><p><strong>Methods: </strong>We reported the count and percentage of categorical outcomes and the median (interquartile range) for numeric outcomes. We produced time series plots of the mean monthly percentage of encounters to different specialties stratified by physician specialty patterns. We evaluated differences in outcomes by physician specialty patterns using analysis of variance (ANOVA) and Pearson's chi-square tests (<i>P</i> < .05, two-tailed).</p><p><strong>Results: </strong>Among 6866 patients, the median age at death was 73, 36.1% were female, and 87.8% resided in urban regions. Three patterns emerged: a primary care, nephrology, and palliative care triad (25.5%); a primary care and nephrology dyad (59.3%); and a non-primary care pattern (15.2%). Palliative care involvement is concentrated near death. Of all, 81.4% spent at least 1 day in hospital or emergency department in the last month, but those with primary care, palliative care, and nephrology involvement had the fewest acute care deaths (65.8%).</p><p><strong>Limitations: </strong>Outpatient care patterns were defined using physician billing codes, potentially missing care from other providers.</p><p><strong>Conclusions: </strong>Nephrology and primary care predominantly manage outpatient care in the last year of life for patients with KF on maintenance dialysis, with consistent acute care use across care patterns except for the place of death. Future research should explore associations between patterns of care and end-of-life outcomes to identify the most optimal model of care for patients with KF on maintenance dialysis.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241280698"},"PeriodicalIF":1.6000,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418337/pdf/","citationCount":"0","resultStr":"{\"title\":\"End-of-Life Care Among Patients With Kidney Failure on Maintenance Dialysis: A Retrospective Population-Based Study.\",\"authors\":\"Shuaib Hafid, Sarina R Isenberg, Aleisha Fernandes, Erin Gallagher, Colleen Webber, Meera Joseph, Manish M Sood, Adrianna Bruni, Janet L Davis, Grace Warmels, James Downar, Anastasia Gayowsky, Aaron Jones, Doug Manuel, Peter Tanuseputro, Michelle Howard\",\"doi\":\"10.1177/20543581241280698\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Nephrologists routinely provide end-of-life care for patients with kidney failure (KF) on maintenance dialysis. Involvement of primary care and palliative care physicians may enhance this experience.</p><p><strong>Objective: </strong>The objective was to describe outpatient care patterns in the last year of life and the end-of-life acute care utilization for patients with KF on maintenance dialysis.</p><p><strong>Design: </strong>Retrospective cohort study using population-level health administrative data.</p><p><strong>Setting & participants: </strong>Outpatient and inpatient care during the last year of life among patients who died between 2017 and 2019, receiving maintenance dialysis in Ontario, Canada.</p><p><strong>Measurements: </strong>The primary exposure is patterns of physician specialties providing outpatient care in the last year of life. Outcomes include outpatient encounters in the last year of life, acute care visitation in the last month of life, and place of death.</p><p><strong>Methods: </strong>We reported the count and percentage of categorical outcomes and the median (interquartile range) for numeric outcomes. We produced time series plots of the mean monthly percentage of encounters to different specialties stratified by physician specialty patterns. We evaluated differences in outcomes by physician specialty patterns using analysis of variance (ANOVA) and Pearson's chi-square tests (<i>P</i> < .05, two-tailed).</p><p><strong>Results: </strong>Among 6866 patients, the median age at death was 73, 36.1% were female, and 87.8% resided in urban regions. Three patterns emerged: a primary care, nephrology, and palliative care triad (25.5%); a primary care and nephrology dyad (59.3%); and a non-primary care pattern (15.2%). Palliative care involvement is concentrated near death. Of all, 81.4% spent at least 1 day in hospital or emergency department in the last month, but those with primary care, palliative care, and nephrology involvement had the fewest acute care deaths (65.8%).</p><p><strong>Limitations: </strong>Outpatient care patterns were defined using physician billing codes, potentially missing care from other providers.</p><p><strong>Conclusions: </strong>Nephrology and primary care predominantly manage outpatient care in the last year of life for patients with KF on maintenance dialysis, with consistent acute care use across care patterns except for the place of death. Future research should explore associations between patterns of care and end-of-life outcomes to identify the most optimal model of care for patients with KF on maintenance dialysis.</p>\",\"PeriodicalId\":9426,\"journal\":{\"name\":\"Canadian Journal of Kidney Health and Disease\",\"volume\":\"11 \",\"pages\":\"20543581241280698\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-09-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418337/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Canadian Journal of Kidney Health and Disease\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/20543581241280698\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Kidney Health and Disease","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/20543581241280698","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0

摘要

背景:肾脏科医生经常为接受维持性透析的肾衰竭(KF)患者提供临终关怀。初级保健和姑息治疗医生的参与可能会改善这种体验:目的:描述维持性透析的肾衰竭患者生命最后一年的门诊护理模式以及临终急症护理的使用情况:设计:使用人群健康管理数据进行回顾性队列研究:2017年至2019年期间在加拿大安大略省接受维持性透析的死亡患者生命最后一年的门诊和住院护理:主要暴露对象是在生命最后一年提供门诊护理的专科医师模式。结果包括生命最后一年的门诊就诊情况、生命最后一个月的急诊就诊情况以及死亡地点:我们报告了分类结果的计数和百分比,以及数字结果的中位数(四分位间距)。我们制作了不同专科每月平均就诊百分比的时间序列图,并按医生专科模式进行了分层。我们使用方差分析(ANOVA)和皮尔森卡方检验(P < .05,双尾)评估了不同专科医生模式的结果差异:在 6866 名患者中,死亡年龄中位数为 73 岁,36.1% 为女性,87.8% 居住在城市地区。出现了三种模式:初级医疗、肾脏内科和姑息治疗三合一(25.5%);初级医疗和肾脏内科二合一(59.3%);以及非初级医疗模式(15.2%)。姑息关怀的参与主要集中在临近死亡时。其中,81.4%的患者在上个月至少在医院或急诊科住院1天,但有初级医疗、姑息治疗和肾内科参与的患者在急诊科死亡的人数最少(65.8%):局限性:门诊护理模式是根据医生账单代码定义的,可能会遗漏其他医疗服务提供者提供的护理:肾脏内科和初级医疗机构主要负责维持性透析的 KF 患者生命最后一年的门诊护理,除死亡地点外,其他护理模式均使用急症护理。未来的研究应探索护理模式与生命末期结果之间的关联,以确定维持性透析的 KF 患者的最佳护理模式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
End-of-Life Care Among Patients With Kidney Failure on Maintenance Dialysis: A Retrospective Population-Based Study.

Background: Nephrologists routinely provide end-of-life care for patients with kidney failure (KF) on maintenance dialysis. Involvement of primary care and palliative care physicians may enhance this experience.

Objective: The objective was to describe outpatient care patterns in the last year of life and the end-of-life acute care utilization for patients with KF on maintenance dialysis.

Design: Retrospective cohort study using population-level health administrative data.

Setting & participants: Outpatient and inpatient care during the last year of life among patients who died between 2017 and 2019, receiving maintenance dialysis in Ontario, Canada.

Measurements: The primary exposure is patterns of physician specialties providing outpatient care in the last year of life. Outcomes include outpatient encounters in the last year of life, acute care visitation in the last month of life, and place of death.

Methods: We reported the count and percentage of categorical outcomes and the median (interquartile range) for numeric outcomes. We produced time series plots of the mean monthly percentage of encounters to different specialties stratified by physician specialty patterns. We evaluated differences in outcomes by physician specialty patterns using analysis of variance (ANOVA) and Pearson's chi-square tests (P < .05, two-tailed).

Results: Among 6866 patients, the median age at death was 73, 36.1% were female, and 87.8% resided in urban regions. Three patterns emerged: a primary care, nephrology, and palliative care triad (25.5%); a primary care and nephrology dyad (59.3%); and a non-primary care pattern (15.2%). Palliative care involvement is concentrated near death. Of all, 81.4% spent at least 1 day in hospital or emergency department in the last month, but those with primary care, palliative care, and nephrology involvement had the fewest acute care deaths (65.8%).

Limitations: Outpatient care patterns were defined using physician billing codes, potentially missing care from other providers.

Conclusions: Nephrology and primary care predominantly manage outpatient care in the last year of life for patients with KF on maintenance dialysis, with consistent acute care use across care patterns except for the place of death. Future research should explore associations between patterns of care and end-of-life outcomes to identify the most optimal model of care for patients with KF on maintenance dialysis.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
3.00
自引率
5.90%
发文量
84
审稿时长
12 weeks
期刊介绍: Canadian Journal of Kidney Health and Disease, the official journal of the Canadian Society of Nephrology, is an open access, peer-reviewed online journal that encourages high quality submissions focused on clinical, translational and health services delivery research in the field of chronic kidney disease, dialysis, kidney transplantation and organ donation. Our mandate is to promote and advocate for kidney health as it impacts national and international communities. Basic science, translational studies and clinical studies will be peer reviewed and processed by an Editorial Board comprised of geographically diverse Canadian and international nephrologists, internists and allied health professionals; this Editorial Board is mandated to ensure highest quality publications.
期刊最新文献
Optimizing Prescribing for Individuals With Type 2 Diabetes and Chronic Kidney Disease Through the Development and Validation of Algorithms for Community Pharmacists. Environmental Sustainability Is Needed in Kidney Care: Patient, Donor, and Provider Perspectives. Genetic Assessment of Living Kidney Transplant Donors: A Survey of Canadian Practices. Home Sweet Home: A Program Report on Promoting the Uptake of Home Dialysis. Definitions of Hemodynamic Instability Related to Renal Replacement Therapy in Critically Ill Patients: A Systematic Review Protocol.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1