Susan C Miller1, Winifred J Scott2, Mary Ersek3, Cari Levy4, Robert Hogikyan5, Vyjeynathi S Periyakoil6, Joan G Carpenter7, Jennifer Cohen8, Mary Beth Foglia9. 1. Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA. Electronic address: Susan_Miller@brown.edu. 2. VA Palo Alto Healthcare System, Palo Alto, California, USA. 3. Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. 4. Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA; University of Colorado Anshutz Medical Campus, Aurora, Colorado, USA. 5. VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA; University of Michigan Medical School, Ann Arbor, Michigan, USA. 6. VA Palo Alto Healthcare System, Palo Alto, California, USA; Stanford University School of Medicine, Palo Alto, California, USA. 7. Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 8. Department of Veterans Affairs, National Center for Ethics in Health Care, Washington, District of Columbia, USA; University of Washington School of Public Health, Seattle, Washington, USA. 9. Department of Veterans Affairs, National Center for Ethics in Health Care, Washington, District of Columbia, USA; University of Washington School of Medicine, Seattle, Washington, USA.
Abstract
CONTEXT: As 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. OBJECTIVES: To evaluate whether goals of "to be comfortable" were associated with greater palliative care (PC) use and lesser acute care use. METHODS: We 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. RESULTS: Sixty-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. CONCLUSION: Findings support the VA's commitment to honoring of Veterans' preferences post introduction of its Life Sustaining Treatment Decisions Initiative. Published by Elsevier Inc.
CONTEXT: As 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. OBJECTIVES: To evaluate whether goals of "to be comfortable" were associated with greater palliative care (PC) use and lesser acute care use. METHODS: We 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. RESULTS: Sixty-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. CONCLUSION: Findings support the VA's commitment to honoring of Veterans' preferences post introduction of its Life Sustaining Treatment Decisions Initiative. Published by Elsevier Inc.
Entities:
Keywords:
Care preferences; End-of-life; Goal-Concordant Care; Veteran
Authors: Mary Ersek; Anne Sales; Shimrit Keddem; Roman Ayele; Leah M Haverhals; Kate H Magid; Jennifer Kononowech; Andrew Murray; Joan G Carpenter; Mary Beth Foglia; Lucinda Potter; Jennifer McKenzie; Darlene Davis; Cari Levy Journal: Implement Sci Commun Date: 2022-07-20