Chikonzero nei maitiro ekutsungirira akasiyana pakati pevarwere vaviri
Tsvakurudzo yakabudiswa mu Journal of the American Medical Association (JAMA) yakawana kusiyana kukuru pakati pevarwere vemuhurumende yehurumende inobhadharisa vanhu vachienzanisa nevanoshamwaridzana navo. Kunyanya, varwere vari kune vanowana mahara vanochengetedza mari vanowanzova nehanya nechekutarisira kwepamusoro uye vanogara muzvipatara kwenguva yakareba kupfuura avo vari kusangano risina rubatsiro rwekuchengetedza.
Tsvaga chokwadi pamusoro pekusiyana nekufananidza pakati pezvibvumirano zvekushambadzira uye zvisina kufanira masangano ekuchengetedza varwere nekuongorora uku.
Kukura Kwemari-Inobatsira Zvipatara Zvipatara
Nzvimbo yekuchengetedza vanhu vanoita zvekuchengetedza yakawedzera zvikuru muzana remakore rechi21. Nhamba yehurumende inobhadharisa mari yakawedzera kubva kubva muna 2000 kusvika muna 2007 apo nhamba yehurumende isingabatsiri yekuchengetedza yakave yakafanana.
Kunyange zvazvo ichivimbisa kuti nhamba yehurumende dzekuchengetedza inowedzera huwandu, inokonzera kushushikana kwekuti masangano ekuchengetedza vanhu vanoita-inobhadharwa ane zvikwereti zvakakwirira zvakanyanya kupfuura zvipatara zvisina kufanira. Chidzidzo cheJAMA chakacherechedza kusiyana kwevanhu vane murwere uye miitiro yezvinyorwa uye zvisingabatsiri masangano kuitira kuti vanzwisise kuti sei kusiyana kwezvibereko kwaive kwakakura.
Medicare Hospice Kubhadhara
Medicare reimbursement inobhadhara 84 muzana yevarwere vari mukuchengetedza vakwegura. Medicare inotsigira masangano ekuchengetedza mahara ekuchengetwa kwekuchengetedza varwere pamutengo wekutengesa, zvichireva murwere wese anowana kuenzana kwakafanana kwekubhadhara zuva nezuva pasinei nekuonekwa kwavo kana kutarisirwa kune mumwe nomumwe.
Iyi nzira yekubhadhara inogona kunge ichiita kuti vashandi vekuchengetedza vachengetedzwe vasarudze varwere vane zvishoma zvido zvekuchengetedza uye nguva refu yekuchengetedza inogara. Nokuita izvi, mapurisa ekubhadhara mari anogona kunge ari kuchengetedza mari nekupa hutano husinganyanyi kuwedzera nekuwedzera mari kuburikidza nekusarudza varwere vanorarama kwenguva refu.
For-Profit Hospitals Inowedzera Dhementira Varwere
Kuongororwa kweJAMA, vatsvakurudzi vakashandisa nhoroondo kubva muna 2007 National Home uye Hospice Care Survey, ine sarudzo yakamirira munyika yose yevanokwana 4 705 vakabviswa kuchipatara.
Kufananidza nhepfenyuro kubva kune vanochengetedza vanhu vanoona nezvekuchengetedza mari uye vasiri vashandi vasiri vaparidzi kwakaratidza kuti zvose zvirwere uye hutano hwekutarisira zvakasiyana-siyana nehuwandu hwehupfumi. Kuenzaniswa nevasina maturo vanoporesa varwere, vanhu vanoita zvekuchengetedza mari vaine chikwata chepakati chevarwere vane kenza (48.4 kubva muzana ne 34.1 muzana) uye yakakwirira yevarwere vane dambudziko (8.4 muzana kubva 17.2 muzana) uye zvimwe zvirwere (43.2 muzana vs. 48.7 muzana ).
Nhoroondo yacho yakaratidzawo kuti inenge zvikamu zviviri kubva muzvitatu zvevarwere muzvipatara zvinobhadharwa nehupfumi zvinokonzerwa nehutano hwemagetsi uye zvimwe zvisiri zvekenza kuongororwa, asi inenge hafu yevarwere muzvipatara vasina ruzivo vaine zvirwere izvi.
Varwere vane kenza vane tarisiro inotarisirwa yehupenyu uye nzira yekurapa. Panguva iyo varwere vanorwara nekenza vanopinda muhutano hwekuchengetedza varwere vakawanda vakaneta mamwe mishonga uye vari pedyo nekufa . Vagari vemagariro ekupedzisira vanogara vachida kutarisirwa zvakanyanya kunetseka nekurwadziwa kwakanyanya uye zviratidzo zvekuchengeta.
Dhementia varwere (uye vamwe varwere vane zvirwere zvisingatarisirwi kuongororwa) vanogara kurarama kwenguva yakareba kupfuura vanorwara nekenza vane hanya. Varwere ava vanobhadhara zvikuru nokuti vanowedzera Medicare hospice pamitambo yezuva nezuva nemari shoma shoma.
Nzvimbo yekuchengetedza uye urefu hwekugara
Kuenzaniswa nevasingabatsiri vezvipatara, vanhu vanoita zvekuchengetedza mari vaine zvikamu zvakakura zvevarwere vanogara mumisha yevachengeti uye vari pasi vanogara pamba.
Varwere vanogara mumisha inochengeterwa vakwegura vanowanzowedzera mari yekuchengetedza varwere mari shoma munguva refu.
Misha inochengetedza vakwegura inenge ichitarisana-in-clock yekuchengetedza iyo inobata mamiriro ezvinhu akawanda apo varwere vomuimba vangada kutarirwa kwekuchengetwa. Nhengo dzekuchengetedza vanhu vanoita basa dzinowanzoita basa rakanaka kwazvo rokutsvaga kumisha yevanotarisira kuti vawane "mukati" neimba yevanamukoti uye kuwedzerwa kutumira mazinga.
Ongororo yeJAMA yakawana kuti kana ichienzaniswa nevarwere vane kenza, avo vane chirwere chekushaya mungozi kana zvimwe zvirwere zvinenge vasati vashanyira zuva rimwe chete kubva kune vanamukoti uye vashandi . Izvi zvinonzwisisika nokuti varwere vekenza vane zviratidzo zvinorema zvakanyanya zvinoda kuongorora nguva dzose.
Nemhaka yokuti masangano ekurapa ari kubhadhara mitero yezuva nezuva nemurwere, varapi vanobatsira-kubatsira vanokwanisa kubhadhara mari nekusarudza varwere avo vachada kushanyirwa vashoma.
Nguva yekuchengetedza yekugara (LOS) ndiyo nhamba yemazuva murwere ari kutarisira kutarisira vasati vasunungurwa kana kufa. Maererano nevanotsvakurudza, miviri yepakati (mikati) LOS yakanga iri mazuva mana kwenguva yakareba muzvipatara zvekuwana mari kana ichienzaniswa nevarapi vasina hanya (mazuva makumi maviri nemazuva gumi nemaviri, kana 26.2 muzana kwenguva refu LOS).
Zvichienzaniswa nevarwere vasiri vapfumi vasina hanya, varwere vari muzvipatara zvekubhadhara mari vaikwanisa kugara nguva refu kupfuura mazuva 365 (2.8 muzana vs. 6.9 muzana) uye vakanga vasingagoni kugara pasi mazuva manomwe (34.3% vs. 28.1 muzana) .
Chirevo cheKutsvakurudza Kuwana
Vatsvakurudzi veJAMA vanoti zvitsvakurudzo zvekudzidza zvine zvakakosha zvinodiwa uye kuti vanhu vasina ruzivo rwekuchengetedza varwere vari pakushata kwakajeka maererano nehuwandu hwevarwere.
"Mwoyo murefu wesarudzo iyi inosiya masangano asina kufanira ehurumende ekuchengetedza varwere asingabatsiri kutarisira varwere vanodhura zvikuru-avo vane kenza uye avo vanoda kutanga kurapa kwenguva refu munguva yavo yekurwara; semugumisiro, avo vanorapa vanoshanda nevarwere vanoshayiwa vanogona kutarisana nezvipingamupinyi zvemari zvakaoma kuti vawane kutarisirwa kwakakodzera mune iyi yakagadzirirwa yega-diem payment system. "
Izvi zvakawanikwa, uye zvinofanirwa, zvinokurudzira kukurukurirana pamusoro pekubhadharwa kwemari mu Medicare Hospice Benefit . Hospice ndeyemabhizimisi ari kukura, kunyanya mune zvekunobatsira, pamwe nekutsvakurudza kwakawanda kunoda kunyatsonzwisisa kuwirirana pakati pechipo chebatsiro uye muchengeti / muchengeti wezviitiko pamagumo ehupenyu.
> Kwakabva:
> Wachterman MW, Marcantonio ER, Davis RB, McCarthy EP. Association of Hospice Agency Kuwana Mamiriro Ezvinhu Nokurapa Kushivirira, Nzvimbo Yekutarisira, uye Kureba Kwekugara. JAMA. 2011; 305 (5): 472-479. doi: 10.1001 / jama.2011.70