Honoring Veterans' Preferences: The Association Between Comfort Care Goals and Care Received at the End of Life.
Honoring Veterans' Preferences: The Association Between Comfort Care Goals and Care Received at the End of Life.
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尊重退伍军人的偏好：舒适护理目标与临终护理之间的关联。
DOI：
10.1016/j.jpainsymman.2020.08.039
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发表时间：
2021
影响因子：
4.7
通讯作者：
Foglia,MaryBeth
中科院分区：
文献类型：
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作者：
Miller,SusanC;Scott,WinifredJ;Ersek,Mary;Levy,Cari;Hogikyan,Robert;Periyakoil,VyjeynathiS;Carpenter,JoanG;Cohen,Jennifer;Foglia,MaryBeth
作为其生命维持治疗（LST）决策倡议的一部分，退伍军人健康管理局（VA）于2017年1月开始要求对患有严重疾病和生命威胁事件高风险的退伍军人的护理目标和偏好进行电子文档记录。我们确定了2018年7月至2019年1月重叠的VA住院或疗养院住院的退伍军人，2019年1月31日记录了LST模板，并且在2019年4月30日死亡（N= 18，163）。从模板文档中，我们确定了一个“舒适”的目标。使用VA和Medicare数据，我们确定了死亡前7天和30天的PC使用（咨询和临终关怀）以及医院，重症监护室和急诊室的使用。多变量Logistic回归研究协会的interests.Results64%的18，163退伍军人有舒适的护理目标; 80%的舒适护理目标接受临终关怀和57%的PC咨询（与57%和46%，分别为死者没有舒适的护理目标）。在校正分析中，死亡前在LST模板上记录的舒适护理与接近生命结束时住院、重症监护室和急诊室使用的几率显著降低相关。在过去的30天的生活，退伍军人与舒适的护理目标有44%的低赔率（调整后的优势比0.57; 95%CI：0.51，0.63）被hospitalized.ConclusionFindings支持退伍军人的承诺，兑现退伍军人的喜好后，推出其生命维持治疗决策倡议。
ContextAs part of its Life-Sustaining Treatment (LST) Decisions Initiative, the Veterans Health Administration (VA) in January 2017 began requiring electronic documentation of goals of care and preferences for Veterans with serious illness and at high risk for life-threatening events.ObjectivesTo evaluate whether goals of “to be comfortable” were associated with greater palliative care (PC) use and lesser acute care use.MethodsWe identified Veterans with VA inpatient or nursing home stays overlapping July 2018–January 2019, with LST templates documented by January 31, 2019, and who died by April 30, 2019 (N= 18,163). From template documentation, we identified a “to be comfortable” goal. Using VA and Medicare data, we determined PC use (consultations and hospice) and hospital, intensive care unit, and emergency department use 7 and 30 days before death. Multivariate logistic regression examined the associations of interest.ResultsSixty-four percent of the 18,163 Veterans had comfort-care goals; 80% with comfort care goals received hospice and 57% PC consultations (versus 57% and 46%, respectively, for decedents without comfort-care goals). In adjusted analyses, comfort care documented on the LST template prior to death was associated with significantly lower odds of hospital, intensive care unit, and emergency department use near the end of life. In the last 30 days of life, Veterans with a comfort care goal had 44% lower odds (adjusted odds ratio 0.57; 95% CI: 0.51, 0.63) of being hospitalized.ConclusionFindings support the VA's commitment to honoring of Veterans' preferences post introduction of its Life Sustaining Treatment Decisions Initiative.