Article type
Year
Abstract
Background: Lack of legal and social support, end-stage health service in China has been in a dilemma. On one hand, doctors do their best to resuscitate patients in the status of brain death. On the other hand, people are not aware of the endpoint of life in a scientific sense. This has greatly handicapped rational and high effective use of health resources in end-of-life care, and influenced equity of health service. Although legislation of brain death has been implemented actively in China, lack of adequate evidence is the present situation we have been meeting.
Objectives: At request of Chinese Ministry of Health, we aim to investigate current situation of end-stage health service and provide scientific evidence for policy-making.
Methods: Literatures about end of-life care were collected from Pubmed and Chinese Bio-Medical disc (CBM) before Dec. 31, 2003. Retrospective analysis of case series was conducted and data were processed by SPSS 10.0.
Results: Although studies by other countries were of high quality, the value for policy-making was limited. Retrospective analysis of case series in biggest hospital of China were conducted . A total of 940 patients from surgical intensive care unit (SICU) were reviewed on treatment and part of direct medical expenditure. Patients were included if they had two of the three symptoms for at least one hour: deep coma, pupillar light reflex disappear, and no autonomic respiratory. Ultimately 115 patients were included, with a total cost of 2,515.9 Yuan per day for each case, whereas mortality was 99.10%. Mortality increased with the state of peri-brain-death prolonged. Eighty percent of patients included were dead within 72 hours after admission. Average expenditure of patients at public expense was higher than out of pocket.
Conclusions: Resuscitate of peri-brain-death patients has been the most widely applied in China. However, it led to great unnecessary consumption of health resources. The government should strengthen legislation of brain death, improve medical insurance system, and highlight education -on people. The doctors should be well informed of and equipped with quality evidence of end-of-life care in their practice.
Objectives: At request of Chinese Ministry of Health, we aim to investigate current situation of end-stage health service and provide scientific evidence for policy-making.
Methods: Literatures about end of-life care were collected from Pubmed and Chinese Bio-Medical disc (CBM) before Dec. 31, 2003. Retrospective analysis of case series was conducted and data were processed by SPSS 10.0.
Results: Although studies by other countries were of high quality, the value for policy-making was limited. Retrospective analysis of case series in biggest hospital of China were conducted . A total of 940 patients from surgical intensive care unit (SICU) were reviewed on treatment and part of direct medical expenditure. Patients were included if they had two of the three symptoms for at least one hour: deep coma, pupillar light reflex disappear, and no autonomic respiratory. Ultimately 115 patients were included, with a total cost of 2,515.9 Yuan per day for each case, whereas mortality was 99.10%. Mortality increased with the state of peri-brain-death prolonged. Eighty percent of patients included were dead within 72 hours after admission. Average expenditure of patients at public expense was higher than out of pocket.
Conclusions: Resuscitate of peri-brain-death patients has been the most widely applied in China. However, it led to great unnecessary consumption of health resources. The government should strengthen legislation of brain death, improve medical insurance system, and highlight education -on people. The doctors should be well informed of and equipped with quality evidence of end-of-life care in their practice.