基于医院的儿童临终关怀（PPC）可能有助于优化儿童严重疾病患者对社区型临终关怀和家庭型临终关怀（HBPC）的转诊，但我们对其转介实践了解甚少。本研究湛述医院PPC团队的社区项目转介情况，确定与转介类型有关的因素及潜在的病人需求与转介之间的错配。对于在2017年被大型城市儿童医院的PPC团队诊治，至少随访6个月或直至去世的患者的病历记录和人口统计学特征以及转介到临终关怀和HBPC的情况进行了图表记录。在302名符合研究条件的患者中，其中25％在2017年首次住院期间去世。在剩下的228名患者中，有42人（18.4％）被转介到HBPC，58人（25.4％）被转介到临终关怀。将转介到临终关怀的患者剔除后，只有三分之一的符合人口统计学条件的患者被转介到HBPC，ICU中看到的患者最不可能被转介。58名转介到临终关怀的患者中有超过一半在研究期内去世（n=34，58.6％）；后代更有可能患有癌症（p=0.002），较少被诊断为神经系统疾病（p=0.021）。尽管符合人口统计学条件，但只有少数被医院PPC团队诊治的患者得到了转介到临终关怀或HBPC。从ICU出院的儿童和神经系统患者可能更容易错过最适合他们需求的转介。未来的研究应确定和解决转介不匹配的原因。可能还需要倡导可适应患者不断变化需求的项目。版权所有©2023年 Elsevier Inc.

Hospital-based pediatric palliative care (PPC) may help optimize referrals to community-based hospice and home-based palliative care (HBPC) for children with serious illness, yet little is known about their referral practices.To describe community-based program referrals from a PPC team, identifying factors associated with referral type, and potential misalignment between patient needs and referral received.Chart abstraction of patients seen in 2017 by the PPC team of a large, urban children's hospital, followed for at least 6 months or until death, including clinical and demographic characteristics, and referrals to hospice and HBPC.Of the 302 study-eligible patients, 25% died during the hospitalization of the first 2017 visit.  Of the remaining 228 patients, 42 (18.4%) were referred to HBPC and 58 (25.4%) to hospice. Excluding patients referred to hospice care, only one-third with demographic eligibility were referred to HBPC; those seen in the ICU were least likely to be referred.  Over half of the 58 patients referred to hospice died within the study period (n=34, 58.6%); descendants were more likely to have cancer (p=.002) and less likely to have a neurologic (p=.021) diagnosis.Despite demographic eligibility, a minority of patients seen by a hospital-based PPC team received referrals for hospice or HBPC.  Children discharged from an ICU and those with neurologic conditions may be at higher risk of missing referrals best aligned with their needs.  Future research should identify and address causes of referral misalignment. Advocacy for programs adaptable to patients' changing needs may also be needed.Copyright © 2023. Published by Elsevier Inc.