功能障碍的住院患者症状负担和死亡率更高。鲜有研究探讨新冠肺炎疫情期间增加的患者数量和病情严重程度如何影响功能障碍患者访问姑息治疗。为了研究 COVID-19 疫情前、期间和后接受住院姑息治疗会诊的患者的功能状态和医院结局的变化。我们进行了一项回顾性的、多中心队列研究，研究了美国纽约市四家医院中，在 2019 年 3 月 1 日至 2022 年 2 月 28 日期间接受住院姑息治疗会诊并在会诊时记录了用 Karnofsky 活动评分量表衡量的功能状态的所有年满 18 岁的成年患者。在识别的 13,180 名符合条件的患者中，患者在疫情爆发后姑息治疗会诊数量增加的情况下功能状态下降。与疫情前相比，在疫情后两年内，非癌症和非 COVID-19 诊断患者的功能状态降低的趋势显著（p<0.001），住院死亡率显著升高（p<0.001）。相比之下，癌症患者的功能状态呈显著上升趋势（p<0.001），住院死亡率随时间无显著变化。当医疗保健系统面临高需求和有限资源的压力时，姑息治疗会诊通过向功能状态较低、住院死亡率较高的患者转移，优先考虑了最高严重程度的患者，而这种转移不成比例地影响了非癌症患者。需要采取创新方法，以确保在资源限制增加时进行提前姑息治疗会诊。版权所有 © 2023，由 Elsevier Inc. 发布。

Hospitalized patients with functional impairment have higher symptom burden and mortality. Little is known about how increased patient volume and acuity during the coronavirus disease 2019 (COVID-19) pandemic affected access to palliative care among patients with functional impairment.To examine changes in functional status and hospital outcomes among patients receiving inpatient palliative care consultation before, during and after the COVID-19 pandemic.We conducted a retrospective, multi-site cohort study of all adult patients (≥ 18 years) admitted to four hospitals in New York City, USA, who received inpatient palliative care consultation between March 1, 2019 and February 28, 2022 with documented functional status at the time of consultation measured by Karnofsky Performance Status scale.Among 13,180 eligible patients identified, patients' functional status at the time of consultation decreased as palliative care consult volume increased with the onset of the pandemic. Compared to pre-pandemic, there was a statistically significant trend of lower functional status (p<0.001) and higher in-hospital mortality (p<0.001) among patients with non-cancer and non-COVID-19 diagnoses two years after the pandemic. In contrast, patients with cancer had a statistically significant trend of higher functional status (p<0.001) and no significant changes in in-hospital mortality over time.As the healthcare system was stressed with high demand and limited resources, palliative care consultation prioritized highest acuity patients by shifting towards those with lower functional status and higher in-hospital mortality. This shift disproportionately affected non-cancer patients. Innovative approaches to ensure upstream palliative care consultation during increased resource constraints are needed.Copyright © 2023. Published by Elsevier Inc.