Veterans' use of inpatient and outpatient palliative care: The national landscape.

Autor: Kaufman BG; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA.; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA., Woolson S; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA., Stanwyck C; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA., Burns M; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA., Dennis P; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA.; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA., Ma J; Geriatric Research, Education, and Clinical Center, Durham VA Health System, Durham, North Carolina, USA.; Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA., Feder S; Yale University School of Nursing, Orange, Connecticut, USA.; West Haven Department of Veterans Affairs, West Haven, Connecticut, USA., Thorpe JM; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.; UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA., Hastings SN; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA.; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.; Geriatric Research, Education, and Clinical Center, Durham VA Health System, Durham, North Carolina, USA.; Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA., Bekelman DB; Department of Veterans Affairs, Department of Medicine, Eastern Colorado Health Care System, Aurora, Colorado, USA.; Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA., Van Houtven CH; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA.; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Nov; Vol. 72 (11), pp. 3385-3397. Date of Electronic Publication: 2024 Aug 23.
DOI: 10.1111/jgs.19141
Abstrakt: Background: Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpatient palliative care. This study aimed to compare veteran characteristics and hospice use for palliative care users across care settings (inpatient vs. outpatient) and dose (number of palliative care encounters).
Methods: This national cohort included veterans with any VA palliative care encounters from 2014 through 2017. We used VA and Medicare administrative data (2010-2017) to describe veteran demographics, socioeconomic status, life-limiting conditions, frailty, and palliative care utilization. Specialty palliative care encounters were identified using clinic stop codes (353, 351) and current procedural terminology codes (99241-99245).
Results: Of 120,249 unique veterans with specialty palliative care over 4 years, 67.8% had palliative care only in the inpatient setting (n = 81,523) and 32.2% had at least one palliative care encounter in the outpatient setting (n = 38,726), with or without an inpatient palliative care encounter. Outpatient versus inpatient palliative care users were more likely to have cancer and less likely to have high frailty, but sociodemographic factors including rurality and housing instability were similar. Duration of hospice use was similar between inpatient (median = 37 days; IQR = 11, 112) and outpatient (median = 44 days; IQR = 14, 118) palliative care users, and shorter among those with only one palliative care encounter (median = 18 days; IQR = 5, 64).
Conclusions: This national evaluation provides novel insights into the care setting and dose of VA specialty palliative care for veterans. Among veterans with palliative care use, one-third received at least some palliative care in the outpatient care setting. Differences between veterans with inpatient and outpatient use motivate the need for further research to understand how care settings and number of palliative care encounters impact outcomes for veterans and older adults.
(© 2024 The American Geriatrics Society.)
Databáze: MEDLINE
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