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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Disparities in Inpatient Intensity of End-of-Life Care for Complex Chronic Conditions
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Disparities in Inpatient Intensity of End-of-Life Care for Complex Chronic Conditions

机译：在综合慢性病条件下居住期末关注的住院强度的差异

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This California administrative database study reveals the rates of and clinical and socioeconomic disparities in inpatient end-of-life care intensity in children with CCCs. BACKGROUND:Children with complex chronic conditions (CCCs) require a disproportionate share of health care services and have high mortality rates, but little is known about their end-of-life care.METHODS:We performed a retrospective population-based analysis using a California State administrative database of children aged 1 to 21 years with a CCC who died of disease-related causes between 2000 and 2013. Rates of and sociodemographic and clinical factors associated with previously defined inpatient end-of-life intensity indicators were determined. The intensity indicators included: (1) hospital death, (2) receipt of a medically intense intervention within 30 days of death (ICU admission, cardiopulmonary resuscitation, hemodialysis, and/or intubation), and (3) having >= 2 intensity markers (including hospital death).RESULTS:There were 8654 children in the study population with a mean death age of 11.8 years (SD 6.8). The 3 most common CCC categories were neuromuscular (47%), malignancy (43%), and cardiovascular (42%). Sixty-six percent of the children died in the hospital, 36% had a medically intense intervention in the last 30 days of life, and 35% had >= 2 intensity markers. Living in a low-income neighborhood was associated with increased odds of hospital death, a medically intense intervention, and >= 2 intensity markers. Hispanic and other race and/or ethnicity were associated with hospital death and >= 2 intensity markers. Age 15 to 21 years was associated with hospital death, a medically intense intervention, and >= 2 intensity markers.CONCLUSIONS:Sociodemographic disparities in the intensity of end-of-life care for children with CCCs raise concerns about whether all children are receiving high-quality and goal-concordant end-of-life care.
机译：这家位于加州管理数据库研究揭示了率和结束时的生活住院治疗强度的临床和社会经济的差距与幼儿中心的儿童。背景：小儿复杂的慢性疾病（CC​​CS）要求的医疗保健服务不成比例，死亡率很高，但鲜为人知的是，结束自己的生命care.METHODS：我们使用加州的一项回顾性人群为基础的分析1岁至21岁有CCC孩子谁的2000年和2013年的价格，并与预先定义的住院结束生命强度指标相关的社会人口学和临床因素之间死于疾病相关原因的国家行政数据库进行了测定。强度指标包括：（1）医院死亡，（2）接收到医学上强烈干预内死亡（ICU入院，心肺复苏，血液透析，和/或插管），和具有> = 2点强度的标记（3）的30天内（包括医院死亡）。结果：有8654名儿童在研究人口11.8岁（SD 6.8），平均死亡年龄。 3个最常见CCC类别是神经肌肉（47％），恶性肿瘤（43％）和心血管（42％）。孩子的六成六在医院抢救无效死亡，36％在生命的最后30天内一种医学干预紧张，35％的有> = 2个的强度指标。生活在低收入邻里增加医院死亡的几率，医学上强烈的干预，以及> = 2个的强度指标相关。西班牙和其他种族和/或种族用医院死亡和> = 2强度的标记相关联。年龄15至21岁与院内死亡，医学上强烈的干预，以及> = 2个强度markers.CONCLUSIONS相关：在结束生活护理的强度差距社会人口儿童与核心承诺提高对所有儿童是否接受高关注 - 质量和最终的生活目标一致的照顾。

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