Effects of Timing of Hospice Care Referral on End-of-Life Care Quality and Health Care Costs in Lung Cancer Patients: A Population-Based Study

肺癌病人轉介安寧療護時機對生命末期照護品質與醫療花費的影響：人口資料庫研究

10.3966/168232812018122804001

江瑞坤(Jui-Kun Chiang)；高以信(Yee-Hsin Kao)

end-of-life ； hospice care ； lung cancer ； timing referral ； 安寧療護 ； 轉介時間 ； 生命末期 ； 肺癌

台灣家庭醫學雜誌

28卷4期（2018 / 12 / 01）

179 - 192

英文

Background: End-of-life (EOL) care quality and health care costs for patients with cancer are critical issues for health care providers. We evaluated the effect of the timing of hospice care referral on care quality and health care costs for patients with lung cancer in their EOL. Methods: Using claims data from the Taiwan National Health Insurance Research Database, we analyzed EOL care quality indicators and health care costs in the last month of life for patients with advanced lung cancer who died during 1997-2011. Results: In total, 566 adult patients with lung cancer who received hospice care were enrolled. The appropriate timing of hospice referral for improving care quality was more than 2 months before death. Compared with patients with a short hospice stay before death (＜2 months), those with a longer hospice stay (＞2 months) had less proportions of one or more quality indicators of EOL care (p=0.002), fewer in-hospital deaths (p＜0.001), as well as lower mean health care costs during the last month of life (NT$43,642 ± 4,997 vs. NT$64,560 ± 2,456, p＜0.001), but more than one hospitalization in the last month of life (p=0.048). Conclusion: Our results suggest that the appropriate timing of hospice referral for patients with advanced lung cancer was more than 2 months before death. Patients with more than 2 months of hospice service had improved EOL care and 32.4% lower health care costs in their last month of life than those with less than 2 months of hospice service.

背景與目的：癌症病人的生命末期照護品質和醫療花費，是健康照護提供者所關心的重要議題。本研究目的在評估安寧療護之轉介時間，對於肺癌病人的生命末期照護品質與醫療花費的影響。方法：我們使用台灣全民健康保險研究資料庫，分析1997 - 2011年間因肺癌死亡的病人，在生命最後一個月的照護指標與醫療花費。結果：共566位接受安寧療護的成年肺癌病人納入分析。肺癌病人轉介安寧療護的適當時間為病人死亡前2個月以上。相較轉介安寧療護時間小於2個月的病人，轉介安寧療護時間大於2個月的病人有顯著較低的比例有一項或多項的生命末期照護品質指標(p=0.002)、較少在醫院死亡的比例(p＜0.001)、以及生命最後一個月的平均醫療花費較低（NT$43,642 ± 4,997相對NT$64,560 ± 2,456，p＜0.001），但是有較多的比例在生命最後一個月住院次數大於一次者(p=0.048)。結論：本研究結果顯示，末期肺癌病人轉介安寧照護的適當時機在病人死亡前2個月以上。肺癌病人接受安寧療護2個月以上者，相較於接受安寧療護小於2個月者，前者有較佳的生命末期照護品質且最後一個月的醫療花費較少32.4%。

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