干旱区生态环境知识资源中心(Arid): Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care

Arid

DOI	10.1001/jamanetworkopen.2020.0038
	Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care
	Courtright, Katherine R.1,2; Jordan, Lizeyka 3; Murtaugh, Christopher M.3; Barron, Yolanda 3; Deb, Partha 4,5; Moore, Stanley 3; Bowles, Kathryn H.3,6; Mikkelsen, Mark E.1,2
通讯作者	Courtright, Katherine R.
来源期刊	JAMA NETWORK OPEN
ISSN	2574-3805
出版年	2020
卷号	3 期号:2
英文摘要	Importance Despite a growing recognition of the increased mortality risk among sepsis survivors, little is known about the patterns of end-of-life care among this population. Objective To describe patterns of end-of-life care among a national sample of sepsis survivors and identify factors associated with long-term mortality risk and hospice use. Design, Setting, and Participants This cohort study assessed sepsis survivors who were Medicare fee-for-service beneficiaries discharged to home health care using national Medicare administrative, claims, and home health assessment data from 2013 to 2014. The initial and final primary analyses were conducted in July 2017 and from July to August 2019, respectively. Exposures Sepsis hospital discharge and 1 or more home health assessments within 1 week. Main Outcomes and Measures Outcomes were 1-year mortality among all sepsis survivors and hospitalization in the last 30 days of life, death in an acute care hospital, and hospice use among decedents. Multivariate logistic regression was used to identify factors associated with 1-year mortality and hospice use. Results Among 87 581 sepsis survivors who were Medicare fee-for-service beneficiaries discharged to home health care, 49 323 (56.3%) were aged 75 years or older, 69 499 (79.4%) were non-Hispanic white, and 48 472 (55.3%) were female. Among the total survivors, 24 423 (27.9%) people died within 1 year of discharge, with a median (interquartile range) survival time of 119 (51-220) days. Among these decedents, 16 684 (68.2%) were hospitalized in the last 30 days of life, 6560 (26.8%) died in an acute care hospital, and 12 573 (51.4%) were enrolled in hospice, with 5729 (45.6%) using hospice for 7 or fewer days. Several factors were associated with 1-year mortality, including a cancer diagnosis (odds ratio [OR], 3.66; 95% CI, 3.50-3.83; P < .001), multiple dependencies of activities of daily living or instrumental activities of daily living (OR, 2.80; 95% CI, 2.57-3.05; P < .001), and an overall poor health status (OR, 2.21; 95% CI, 2.01-2.44; P < .001) documented on home health assessment. Among the decedents, cancer was associated with hospice use (OR, 2.25; 95% CI, 2.11-2.41; P < .001), patients aged 85 years or older (OR, 1.49; 95% CI, 1.37-1.61; P < .001), and living in an assisted living setting (OR, 1.93; 95% CI, 1.69-2.19; P < .001). Conclusions and Relevance The findings of this study suggest that death within 1 year after sepsis discharge may be common among Medicare beneficiaries discharged to home health care. Although 1 in 2 decedents used hospice, aggressive care near the end of life and late hospice referral were common. Readily identifiable risk factors suggest opportunities to target efforts to improve palliative and end-of-life care among high-risk sepsis survivors. This cohort study examines the risk factors for long-term mortality and the patterns of end-of-life care among a national population of adult sepsis survivors who are Medicare fee-for-service beneficiaries and have been discharged to home health care. Question What are the risk factors for long-term mortality and patterns of end-of-life care among sepsis survivors who are Medicare beneficiaries and have been discharged to home health care? Findings In this cohort study of 87 581 adult sepsis survivors who are Medicare fee-for-service beneficiaries and have been discharged to home health care, 1 in 4 survivors died within 1 year, and among the decedents, hospitalization and intensive care unit use in the last 30 days of life and in-hospital death were common. Several factors were found to be associated with an increased risk of mortality. Meaning The findings of this study suggest that home health assessments may provide an opportunity to identify high-risk sepsis survivors and target efforts to improve their end-of-life care.
类型	Article
语种	英语
国家	USA
开放获取类型	Green Published, gold
收录类别	SCI-E ; SSCI
WOS记录号	WOS:000518634000007
WOS关键词	COGNITIVE IMPAIRMENT ; HOSPICE CARE ; READMISSIONS ; ASSOCIATION ; SERVICES ; VALIDITY ; DEATH ; OASIS
WOS类目	Medicine, General & Internal
WOS研究方向	General & Internal Medicine
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/314833
作者单位	1.Univ Penn, Div Pulm Allergy & Crit Care, Perelman Sch Med, Philadelphia, PA 19104 USA; 2.Univ Penn, PAIR Ctr, Perelman Sch Med, Philadelphia, PA 19104 USA; 3.Visiting Nurse Serv New York, Ctr Home Care Policy & Res, New York, NY USA; 4.CUNY Hunter Coll, Dept Econ, New York, NY 10021 USA; 5.NBER, Cambridge, MA 02138 USA; 6.Univ Penn, Sch Nursing, Dept Biobehav Hlth Sci, Philadelphia, PA 19104 USA
推荐引用方式 GB/T 7714	Courtright, Katherine R.,Jordan, Lizeyka,Murtaugh, Christopher M.,et al. Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care[J],2020,3(2).
APA	Courtright, Katherine R..,Jordan, Lizeyka.,Murtaugh, Christopher M..,Barron, Yolanda.,Deb, Partha.,...&Mikkelsen, Mark E..(2020).Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care.JAMA NETWORK OPEN,3(2).
MLA	Courtright, Katherine R.,et al."Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care".JAMA NETWORK OPEN 3.2(2020).