Understanding Access to Hospice Care

了解临终关怀的获取

基本信息

批准号：
7813566
负责人：
MELISSA Diane ALDRIDGE
金额：
$ 21.28万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-08-06 至 2012-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7813566
关键词：
Address Advance Care Planning Age Anxiety Applications Grants Automobile Driving Award Bereavement Caregiver Burden Caregivers Caring Categories Censuses Certification Cessation of life Characteristics Chronic Disease Communities Community Outreach Computer software Counseling Country Data Dementia Disease Elderly Emotional Enrollment Environment Family Family Caregiver Geographic Locations Goals Growth Healthcare Systems Heart Diseases Home environment Hospice Care Human Resources Improve Access Income Individual Industry Information Technology Inpatients Interview Leadership Life Expectancy Life Support Care Linear Models Link Location Logistic Regressions Manuscripts Marketing Measures Medical Medicare Mentors Movement Organizational Culture Pain Pain management Palliative Care Patient Care Patients Performance Personal Satisfaction Phase Population Principal Investigator Process Provider Qualitative Research Quality Indicator Quality of Care Research Research Methodology Rural Sampling Services Site Visit Social Work Staging Stress Structure Surveys Symptoms System Tax Equity and Fiscal Responsibility Act Techniques Testing Time United States Universities Variant base beneficiary cancer diagnosis coping depression design end of life care experience follow-up hospice environment improved innovation interdisciplinary approach meetings palliative patient home care psychosocial racial and ethnic respite care satisfaction social socioeconomics symptom management volunteer

项目摘要

Three-quarters of individuals in the United States die from chronic illnesses,40 often after suffering both physically and psychologically for months or years.41 Recent evidence19-22 establishes the importance to patients and families coping with serious illness of receiving services across multiple domains that address the patient's physical, psychosocial and spiritual well-being, as well as the caregiver's well-being. However, the health care system has often failed to meet the needs of patients suffering from advanced illness and their families, who frequently experience inadequate pain and symptom management, 42-46 significant caregiver burden and stress,47,46 and overall dissatisfaction with care. Hospice was developed to address the multidimensional needs of patients suffering from serious illness and their families that were not being met by the traditional medical system. Hospice consists of services that focus on the physical, emotional, social, and spiritual needs of patients and their families including medical services, pain and symptom management, spiritual counseling, social services, and bereavement counseling. Services are palliative, rather than curative, and the majority of hospice care is provided in the patient's home.18 The population enrolled with hospice is rapidly diversifying as greater understanding of its benefits, particulariy for older adults with chronic illnesses, becomes wide-spread. Almost two-thirds of individuals enrolled with hospice are age 75 years or older.18 Individuals with a terminal diagnosis of cancer comprise 46% of all individuals enrolled with hospice, followed by those with end-stage heart disease (12%) and dementia (10%).18 The Tax Equity and Fiscal Responsibility Act of 1982 authorized Medicare to reimburse for hospice care under the Medicare Hospice Benefit (Table 1). In order for individuals to be eligible for hospice they must have a life expectancy of 6 months or less if the disease follows its usual course and must be willing to relinquish Medicare reimbursed services focused on life prolongation or cure. In order for hospices to receive reimbursement for hospice care they must be certified by Medicare.50 Medicare is the primary payor of hospice and approximately 94% 18 of hospices are Medicare certified. Certification requires satisfying several "conditions of participation 50 related to the availability of hospice services and the types of personnel that must be employed by the hospice. Reimbursement for hospice under Medicare is on a per diem basis according to four categories depending on the intensity of care delivered: routine home care, continuous home care (i.e., home care provided during periods of patient crisis), respite care (i.e., inpatient care for a short period to relieve the caregiver) and general inpatient care (i.e., inpatient care for patients unable to remain at home).51 More than 95% of hospice care reimbursed by Medicare is for routine home care.35

在美国，四分之三的人死于慢性疾病，40 通常是在身心遭受数月或数年的痛苦之后。41 最近的证据19-22 证实了接受跨多个领域的服务对于应对严重疾病的患者和家庭的重要性，解决患者的身体、心理和精神健康以及护理人员的健康。然而，医疗保健系统往往无法满足晚期疾病患者及其家人的需求，他们经常遇到疼痛和症状管理不足、42-46 护理人员负担和压力很大，47,46 以及对护理的总体不满意。临终关怀的发展是为了解决传统医疗系统无法满足的重病患者及其家人的多维需求。临终关怀服务的重点是患者及其家人的身体、情感、社会和精神需求，包括医疗服务、疼痛和症状管理、精神咨询、社会服务和丧亲咨询。服务是姑息性的，而不是治疗性的，并且大多数临终关怀护理是在患者家中提供的。18 随着人们对临终关怀的好处（尤其是患有慢性病的老年人）的了解越来越广泛，参加临终关怀的人群正在迅速多样化。近三分之二登记参加临终关怀的个人年龄为 75 岁或以上。 18 癌症晚期诊断的个人占所有登记参加临终关怀的个人的 46%，其次是患有终末期心脏病 (12%) 和痴呆症的人 (12%)。 10%).18 1982 年《税收公平和财政责任法案》授权 Medicare 根据 Medicare 临终关怀福利报销临终关怀费用（表1）。为了使个人有资格接受临终关怀，如果疾病按照通常的病程发展，他们的预期寿命必须为 6 个月或更短，并且必须愿意放弃专注于延长生命或治愈的 Medicare 报销服务。为了让临终关怀机构获得临终关怀报销，它们必须获得 Medicare 认证。50 Medicare 是临终关怀机构的主要付款人，大约 94% 18 的临终关怀机构获得了 Medicare 认证。认证要求满足若干“参与条件 50，这些条件与临终关怀服务的可用性以及临终关怀机构必须雇用的人员类型有关。医疗保险下临终关怀的报销是按每日津贴为基础，根据护理强度分为四个类别提供：常规家庭护理、持续家庭护理（即在患者危机期间提供的家庭护理）、暂托护理（即短期住院护理以减轻护理人员的负担）和一般护理住院护理（即为无法留在家中的患者提供住院护理）51 Medicare 报销的临终关怀中 95% 以上用于常规家庭护理。 35