Association Between Symptom Burden and Time to Hospitalization, Nursing Home Placement, and Death Among the Chronically Ill Urban Homebound

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• 作者：Nancy Yang ; BA ; ^{nancy.yang@icahn.mssm.edu" class="auth_mail" title="E-mail the corresponding author} ; Katherine A. Ornstein ; PhD ; MPH ; Jennifer M. Reckrey ; MD
• 关键词：Homebound ; symptom burden ; home-based primary care ; elderly ; multimorbidity
• 刊名：Journal of Pain and Symptom Management
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：52
• 期：1
• 页码：73-80
• 全文大小：230 K

文摘

Homebound adults experience significant symptom burden.

Objectives

To examine demographic and clinical characteristics associated with high symptom burden in the homebound, and to examine associations between symptom burden and time to hospitalization, nursing home placement, and death.

Methods

Three hundred eighteen patients newly enrolled in the Mount Sinai Visiting Doctors Program, an urban home-based primary care program, were studied. Patient sociodemographic characteristics, symptom burden (measured via the Edmonton Symptom Assessment Scale), and incidents of hospitalization, nursing home placement, and death were collected via medical chart review. Multivariate Cox proportional hazards models were used to analyze the effect of high symptom burden on time to first hospitalization, nursing home placement, and death.

Results

Of the study sample, 45% had severe symptom burden (i.e., Edmonton Symptom Assessment Scale score >6 on at least one symptom). Patients with severe symptom burden were younger (82.0 vs. 85.5 years, P < 0.01), had more comorbid conditions (3.2 vs. 2.5 Charlson score, P < 0.01), higher prevalence of depression (43.4% vs. 12.0%, P < 0.01), lower prevalence of dementia (34.3% vs. 60.6%, P < 0.01), and used fewer hours of home health services (73.6 vs. 94.4 hours/wk, P < 0.01). Severe symptom burden was associated with a shorter time to first hospitalization (hazard ratio = 1.51, 95% CI 1.06–2.15) in adjusted models but had no association with time to nursing home placement or death.

Conclusion

The homebound with severe symptom burden represents a unique cohort of patients who are at increased risk of hospitalization. Tailored symptom management via home-based primary and palliative care programs may prevent unnecessary health care utilization in this population.