A comparison of end-of-life care quality for Veterans receiving hospice in VA nursing homes and community nursing homes.
A comparison of end-of-life care quality for Veterans receiving hospice in VA nursing homes and community nursing homes.
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在退伍军人管理局疗养院和社区疗养院接受临终关怀的退伍军人临终护理质量的比较。
DOI：
10.1111/jgs.18606
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发表时间：
2024
影响因子：
6.3
通讯作者：
Kutney-Lee,Ann
中科院分区：
文献类型：
--
作者：
Wachterman,MelissaW;Smith,Dawn;Carpenter,JoanG;Griffin,HillaryL;Thorpe,Joshua;Feder,ShelliL;Hoelter,Jillian;Ersek,Mary;Shreve,Scott;Kutney-Lee,Ann
背景虽然退伍军人健康管理局(VA)长期以来一直在退伍军人社区生活中心(CLC，即退伍军人疗养院)提供临终关怀，但越来越多的退伍军人在退伍军人健康管理局签约的社区疗养院(CNH)接受临终关怀。然而，关于CNH提供的临终关怀(EOL)质量的数据很少。本研究的目的是比较家庭对退伍军人在退伍军人医院和退伍军人医院接受临终关怀的质量的评价。方法我们对退伍军人在2021年10月至2022年3月期间在退伍军人医院接受临终关怀的退伍军人的电子病历和丧亲家庭调查(BFS)数据进行了回顾分析。最终样本包括1238名退伍军人，他们死于CLC(n= 1012)或CNH(n= 226)，其近亲完成了BFS。我们的主要结果是BFS对生命最后30 天内接受的护理进行全球评级。次要结果包括与症状管理、沟通、情感和精神支持有关的BFS项目，以及关于埋葬和遗属福利的信息。我们比较了接受CLCS和CNH临终关怀的退伍军人中所有BFS结果的未经调整和调整后的比例。结果在退伍军人中接受临终关怀的退伍军人中，在VA CLC接受临终关怀的退伍军人的调整后比例比在VA合同CNH接受临终关怀的退伍军人高出13个百分点以上。我们的发现还揭示了在特定的EOL护理重点领域存在的更大的质量差距。结论我们的发现证明了在CNH临终关怀中为退伍军人提供的EOL护理的多个方面的质量不足，并阐明了迫切需要政策和实践干预来改善这种护理。
BackgroundWhile the Veterans Health Administration (VA) has long provided hospice care within VA community living centers (CLCs, i.e., VA nursing homes), an increasing number of Veterans are receiving hospice in VA‐contracted community nursing homes (CNHs). However, little data exist about the quality of end‐of‐life (EOL) care provided in CNHs. The aim of this study was to compare family ratings of the quality of EOL care provided to Veterans receiving hospice in VA CLCs and VA‐contracted CNHs.MethodsWe conducted a retrospective analysis of national data from VA's electronic medical record and Bereaved Family Survey (BFS) for Veterans who received hospice in VA CLCs or VA‐contracted CNHs between October 2021 and March 2022. The final sample included 1238 Veterans who died in either a CLC (n= 1012) or a CNH (n= 226) and whose next‐of‐kin completed the BFS. Our primary outcome was the BFS global rating of care received in the last 30 days of life. Secondary outcomes included BFS items related to symptom management, communication, emotional and spiritual support, and information about burial and survivor benefits. We compared unadjusted and adjusted proportions for all BFS outcomes between those who received hospice in CLCs and CNHs.ResultsThe adjusted proportion of family members who gave the best possible rating (a score of 9 or 10 out of a possible 10) for the overall care received near EOL was more than 13 percentage points higher for Veterans who received hospice in VA CLCs compared to VA‐contracted CNHs. Our findings also revealed quality gaps of even greater magnitude in specific EOL care‐focused domains.ConclusionsOur findings document inadequacies in the quality of multiple aspects of EOL care provided to Veterans in CNH‐based hospice and illuminate the urgent need for policy and practice interventions to improve this care.
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