Autopsy rates remain disturbingly low in nursing homes despite the fact that 1 of 5 deaths occurs in this setting. To determine the autopsy rate for nursing homes, we analyzed all deaths occurring in New York State nursing homes from 1980 to 1984. Of 58,985 nursing home deaths, autopsies were performed in only 499 cases (0.8%). In comparison to the general nursing home population, autopsied residents were more likely to be male and never married and less likely to be widowed. Of 110 practicing nursing home physicians surveyed, 19% believed autopsies had little if any value in the nursing home population, whereas 71% saw autopsy as a valuable tool but rarely requested one. Fewer than 1 in 10 physicians routinely discussed autopsies with patients and/or families before death. Perceived obstacles included the emotional lability of patients and families and a lack of financial reimbursement. Concerns over religious objections, funeral delays, and unnecessary mutilation were cited by fewer than one third of respondents. Facilitation of consent, physician education, and cost sharing may all contribute to enhanced rates of autopsies in the future.

译文

尽管5例死亡中有1例发生在这种情况下,疗养院的尸检率仍然低得令人不安。为了确定疗养院的尸检率,我们分析了1984年1980年在纽约州疗养院发生的所有死亡。在58,985例疗养院死亡中,只有499例 (0.8% 例) 进行了尸检。与一般疗养院人口相比,经过尸检的居民更有可能是男性且从未结婚,也不太可能丧偶。在接受调查的110名执业疗养院医生中,19% 人认为尸检对疗养院人群几乎没有价值,而71% 人认为尸检是一种有价值的工具,但很少要求尸检。在死亡前,只有不到十分之一的医生与患者和/或家属进行常规尸检。感知到的障碍包括患者和家人的情绪不安和缺乏经济补偿。不到3分之1的受访者提到了对宗教异议,葬礼延误和不必要的肢解的担忧。同意的便利,医师教育和费用分担都可能有助于将来提高尸检率。

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