Exploring End-of-Life Care in Veterans Affairs Community Living Centers
Exploring End-of-Life Care in Veterans Affairs Community Living Centers
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DOI：
10.1111/jgs.13348
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发表时间：
2015-04-01
影响因子：
6.3
通讯作者：
Smith, Dawn
中科院分区：
文献类型：
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作者：
Ersek, Mary;Thorpe, Joshua;Smith, Dawn
目的比较社区生活中心(CLCs)与急诊、重症、临终关怀和姑息治疗单位的临终关怀质量指标和家庭评估。设计回顾图表并对最近去世的住院患者的近亲进行调查。设置全美145个住院退伍军人事务(VA)医疗中心，包括132个CLCs。参与者图表回顾包括所有在VA住院病房死亡的个人(n=57,397)。家庭调查结果包括33,497名退伍军人的数据。衡量最佳终生关怀的指标：生命最后90天的姑息咨询，与牧师的接触，与牧师的家人接触，以及死后给予家人的情感支持。主要结果是一个单一的丧亲家庭调查项目，受访者提供了对EOL护理质量的全球评估(从优秀到非常好，从好到差)。结果在CLC死亡的退伍军人对整体EOL护理的家庭评估和EOL护理质量指标优于在急性或重症监护病房死亡的退伍军人，但比在临终关怀或姑息护理单元死亡的退伍军人更差。结论CLCS的护理可以通过整合姑息护理实践来加强。未来的研究应该确定在养老院加强EOL护理的关键要素。
ObjectivesTo compare quality of end-of-life (EOL) care indicators and family evaluation of care in community living centers (CLCs) with that of EOL care in acute, intensive, and hospice and palliative care units.DesignRetrospective chart review and survey with next of kin of recently deceased inpatients.SettingInpatient Veterans Affairs (VA) Medical Centers (N=145), including 132 CLCs, across the United States.ParticipantsThe chart review included all individuals who died in VA inpatient units (n=57,397). Family survey results included data for 33,497 veterans.MeasurementsIndicators of optimal EOL care: palliative consultation in the last 90days of life, contact with a chaplain, family contact with a chaplain, and emotional support given to family after death. The main outcome was a single Bereaved Family Survey item in which respondents provided a global evaluation of quality of EOL care (excellent to very good, good, fair to poor).ResultsFamily evaluations of overall EOL care and quality of EOL care indicators for veterans who died in CLCs were better than those of veterans dying in acute or intensive care units but worse than those dying in hospice or palliative care units.ConclusionCare in CLCs can be enhanced through the integration of palliative care practices. Future research should identify critical elements of enhancing EOL care in nursing homes.