The utilization of hospice care among patients with motor neuron diseases: The experience in Taiwan from 2005 to 2010

医学 肌萎缩侧索硬化 机械通风 胃造口术 急诊医学 共病 疾病 医疗保健 重症监护医学 运动神经元病 临终关怀 缓和医疗 内科学 护理部 外科 经济 经济增长
作者
Shih-Chao Kang,Shinn‐Jang Hwang,Pin-Yuan Wu,Ching‐Piao Tsai
出处
期刊:Journal of The Chinese Medical Association [Ovid Technologies (Wolters Kluwer)]
卷期号:76 (7): 390-394 被引量:3
标识
DOI:10.1016/j.jcma.2013.03.012
摘要

Background: The nature and extent of how patients with motor neuron diseases (MNDs) utilize hospice care in Taiwan remains unclear. This study aims to investigate the use of hospice care in Taiwan by patients with MND, and those factors that affect the extent, the cost, and the quality of their hospice treatment and care. Methods: We analyzed data from hospice care inpatient claims of MNDs, using the National Health Insurance Research Database of Taiwan during 2005–2010. Results: Thirty patients and 58 related discharges were enrolled into our study, which consisted of 13 males and 17 females, with a mean age 58.3 years. Of that total, 27 of them (90%) had amyotrophic lateral sclerosis, and four (13.3%) had comorbid cancers; 17 died during hospice care. Acute low respiratory conditions (31.0%) accounted for the most common acute comorbidity. Noninvasive ventilation care was performed in only 13 (22.4%) of the discharges. In contrast to nasogastric intubation (40 discharges, 69.0%), no gastrostomy/jejunostomy was noted. These procedures bore no relationship to results observed in the discharges. Family physicians provided most inpatient hospice services (74.1%). Respiratory problems were the major causes of death (70.6% of decedents). The mean inpatient costs of hospice care were noticeably reduced from previously established nationwide mean costs. Conclusion: Hospice care can save costs for patients with terminal MNDs, and family physicians play a valuable role in caring for these patients. However, respiratory and feeding problems are prevalent, yet there are proven benefits when noninvasive ventilation care and gastrostomy/jejunostomy are promoted.

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