Families' Perceptions of End-of-Life Care in Veterans Affairs versus Non-Veterans Affairs Facilities
Families' Perceptions of End-of-Life Care in Veterans Affairs versus Non-Veterans Affairs Facilities
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DOI：
10.1089/jpm.2010.0044
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发表时间：
2010-08-01
影响因子：
2.8
通讯作者：
Casarett, David
中科院分区：
文献类型：
--
作者：
Lu, Hien;Trancik, Emily;Casarett, David
背景：退伍军人事务部（VA）在退伍军人护理方面进行了大量投资。然而，与其他机构相比，这些投资是否改善了退伍军人事务部的临终关怀尚不清楚。因此，本研究的目的是比较在退伍军人医院和非退伍军人医院死亡的患者的家庭对临终关怀的看法。设计：对在退伍军人医院和非退伍军人医院死亡的患者家属进行回顾性32项电话调查。环境：五个退伍军人事务医疗中心及其附属疗养院和门诊诊所。参与者：如果患者在生命的最后一个月接受过参与VA设施的任何护理，并且如果他们在住院环境中死亡，则符合资格。每位患者有一名家庭成员完成调查。结果：在双变量分析中，死于退伍军人医院的患者（n = 520）比死于非退伍军人医院的患者有更高的平均满意度得分（n = 89； 59比51；秩和检验p = 0.002）。在调整医疗中心后，在VA死亡的人的总体得分仍然显着较高（beta = 0.07；置信区间[CI] 0.02-0.11; p = 0.004），在死亡时间附近测量护理的领域也是如此（beta = 0.11; CI = 0.04-0.17; p = 0.001）。结论：在退伍军人管理局机构死亡的患者家属认为护理比在非退伍军人管理局机构死亡的患者家属更好。这些结果提供了初步证据，表明与非VA设施相比，VA在临终关怀方面的投资有助于改善VA设施的护理。
Background: The Veterans Affairs (VA) has made significant investments in care for veterans. However, it is not known whether these investments have produced improvements in end-of-life care in the VA compared to other settings. Therefore, the goal of this study was to compare families' perceptions of end-of-life care among patients who died in VA and non-VA facilities.Design: Retrospective 32-item telephone surveys were conducted with family members of patients who died in VA and non-VA facilities.Setting: Five Veterans Affairs medical centers and their affiliated nursing homes and outpatient clinics.Participants: Patients were eligible if they received any care from a participating VA facility in the last month of life and if they died in an inpatient setting. One family member per patient completed the survey.Results: In bivariate analysis, patients who died in VA facilities (n = 520) had higher mean satisfaction scores compared to those who died in non-VA facilities (n = 89; 59 versus 51; rank sum test p = 0.002). After adjusting for medical center, the overall score was still significantly higher for those dying in the VA (beta = 0.07; confidence interval [CI] 0.02-0.11; p = 0.004), as was the domain measuring care around the time of death (beta = 0.11; CI = 0.04-0.17; p = 0.001).Conclusion: Families of patients who died in VA facilities rated care as being better than did families of those who died in non-VA facilities. These results provide preliminary evidence that the VA's investment in end-of-life care has contributed to improvements in care in VA facilities compared to non-VA facilities.