Family members' experience improves with care preference documentation in home based primary care.
Family members' experience improves with care preference documentation in home based primary care.
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DOI：
10.1111/jgs.17410
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发表时间：
2021-12
影响因子：
6.3
通讯作者：
Ersek, Mary
中科院分区：
文献类型：
--
作者：
Levy, Cari;Esmaeili, Aryan;Smith, Dawn;Hogikyan, Robert;Periyakoil, Vyjeyanthi;Carpenter, Joan G.;Sales, Anne;Ersek, Mary
退伍军人健康管理局 (VA) 实施了综合生命维持治疗 (LST) 决策计划，为重病退伍军人提供培训和标准化护理目标和 LST 偏好记录，以改善临终 (EOL) 结局。 LST 文件预计适用于所有家庭初级保健 (HBPC) 退伍军人，因为他们住院和死亡的风险很高。一项回顾性横断面分析比较了丧亲家庭调查 (BFS) EOL 护理评级与 LST 文档之间的关联。参与者是 2018 年 8 月 1 日至 2019 年 9 月 30 日期间在 55 个 VA HBPC 项目之一中去世的退伍军人。回归模型生成关键 BFS 结果的赔率。 LST 模板完成率按月绘制，以了解时间、LST 完成率和 EOL 护理家庭评级之间的相互作用。 39% 的 HBPC 退伍军人记录了 LST 偏好。 53% 的退伍军人的家庭成员将整体 EOL 护理评为优秀，但在研究的最后 7 个月中，BFS 评分出现显着差异，LST 完成者的 60% 的家庭成员将护理评为优秀，而缺乏 LST 文件的退伍军人的这一比例为 48%（p = 0.003）。对于那些拥有完整 LST 模板的人来说，在生命最后一个月将整体护理评为优秀的调整后几率较高 (1.64 95% CI 1.19, 2.26)。 LST 记录率越高，EOL 评级越有利，但在实施综合举措后的最初几个月内则不然；然而，HBPC 退伍军人的 LST 记录率低于预期。在实施一项旨在促进退伍军人在严重疾病期间选择护理的综合性国家举措的初始阶段后，记录在案的 LST 偏好与家庭对 EOL 护理的更好评级相关。 HBPC 临床医生可以通过使用 LSDTI 工具和培训来获取和记录偏好，从而改善失去亲人的家庭的体验。
The Veterans Health Administration (VA) implemented the comprehensive life-sustaining treatment (LST) Decisions Initiative to provide training and standardize documentation of goals of care and LST preferences for seriously ill Veterans to improve end-of-life (EOL) outcomes. LST documentation is expected for all Home-Based Primary Care (HBPC) Veterans because they are at high risk of hospitalization and mortality. A retrospective, cross-sectional analysis compared associations between Bereaved Family Survey (BFS) EOL care ratings and LST documentation. Participants were Veterans who died August 1, 2018 through September 30, 2019 in one of 55 VA HBPC programs. Regression modeling generated odds for key BFS outcomes. LST template completion rate was plotted by month to understand the interaction between time, LST completion rate, and EOL care family ratings. LST preferences were documented for 39% of HBPC Veterans. Family members rated overall EOL care as excellent for 53% of Veterans but significant divergence in BFS ratings occurred during the last 7 months of the study with 60% of family members of LST completers rating care as excellent compared with 48% for Veterans lacking LST documentation (p = 0.003). The adjusted odds of rating overall care in the final month of life as excellent was higher among those with a completed LST template (1.64 95% CI 1.19, 2.26). Higher rates of LST documentation were associated with more favorable ratings of EOL but not in initial months following implementation of the comprehensive initiative; however, LST documentation rates were lower than expected among HBPC Veterans. Following an initial period of implementation of a comprehensive national initiative to promote Veteran choice about care during serious illness, documented LST preferences were associated with better family ratings of EOL care. HBPC clinicians may improve the bereaved family experience by using LSDTI tools and training to elicit and document preferences.
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影响因子：
3
作者：
Baldwin, Laura-Mae;Klabunde, Carrie N.;Wright, George
通讯作者：
Wright, George
影响因子：
2.8
作者：
Smith, Dawn;Kuzla, Natalie;Ersek, Mary
通讯作者：
Ersek, Mary
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
4.7
作者：
Thorpe, Joshua M.;Smith, Dawn;Ersek, Mary
通讯作者：
Ersek, Mary
DOI：
10.1177/1049909117752669
发表时间：
2018-07-01
影响因子：
1.9
作者：
Kutney-Lee, Ann;Carpenter, Joan;Ersek, Mary
通讯作者：
Ersek, Mary