Assuntos
Recidiva , Tonsilectomia , Tonsilite , Humanos , Tonsilite/cirurgia , Criança , Resultado do TratamentoAssuntos
Doenças Cardiovasculares , Complicações do Diabetes , Serviços Preventivos de Saúde , Humanos , Diabetes Mellitus , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Complicações do Diabetes/complicações , Complicações do Diabetes/terapiaRESUMO
BACKGROUND: Information on the use of palliative care and aggressive treatments for terminally ill patients who receive care from hospitalists is limited. METHODS: This three-year, retrospective, case-control study was conducted at an academic medical center in Taiwan. Among 7037 patients who died in the hospital, 41.7% had a primary diagnosis of cancer. A total of 815 deceased patients who received hospitalist care before death were compared with 3260 patients who received non-hospitalist care after matching for age, gender, catastrophic illness, and Charlson comorbidity score. Regression models with generalized estimating equations were performed. RESULTS: Patients who received hospitalist care before death, compared to those who did not, had a higher probability of palliative care consultation (odds ratio (OR) = 3.41, 95% confidence interval (CI): 2.63-4.41), and a lower probability to undergo invasive mechanical ventilation (OR = 0.13, 95% CI: 0.10-0.17), tracheostomy (OR = 0.14, 95% CI: 0.06-0.31), hemodialysis (OR = 0.70, 95% CI: 0.55-0.89), surgery (OR = 0.25, 95% CI: 0.19-0.31), and intensive care unit admission (OR = 0.11, 95% CI: 0.08-0.14). Hospitalist care was associated with reductions in length of stay (coefficient (B) = -0.54, 95% CI: -0.62--0.46) and daily medical costs. CONCLUSIONS: Hospitalist care is associated with an improved palliative consultation rate and reduced life-sustaining treatments before death.