Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University (OHSU), Portland, Oregon, USA.
Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Healthcare System, Portland, Oregon, USA.
J Palliat Med. 2022 Jan;25(1):15-20. doi: 10.1089/jpm.2021.0246. Epub 2021 Oct 19.
Palliative care (PC) is beneficial, however, in many settings it is under-resourced and unable to consistently meet the needs of patients and their families. A lack of national health policy support for PC contributes to underutilization and the low value care experienced by many patients with serious illness at the end of life. Through a series of transformative health care structure and process improvements including developing robust initiatives and promoting institutional culture change, the Department of Veterans Affairs (VA) has significantly improved the quality of PC among veterans. VA's strategic simultaneous top-down and bottom-up approach to develop programs, policies, and initiatives provides important perspectives and deserves attention toward advancing PC in the broader U.S. health care system. Although opportunities for improvement exist, the comprehensive framework within VA should help inform the future of program development and serve as a model for integrated and accountable care organizations to emulate.
缓和医疗（PC）是有益的，然而，在许多情况下，它的资源不足，无法始终满足患者及其家属的需求。国家对 PC 的卫生政策支持不足，导致许多患有严重疾病的患者在生命末期的使用率和低价值护理。通过一系列变革性的医疗保健结构和流程改进，包括制定强有力的举措和促进机构文化变革，美国退伍军人事务部（VA）显著提高了退伍军人的 PC 质量。VA 采用战略上自上而下和自下而上的方法来制定计划、政策和举措，为推进更广泛的美国医疗保健系统中的 PC 提供了重要的视角，值得关注。尽管存在改进的机会，但 VA 内的综合框架应该有助于为计划的发展提供信息，并作为综合和负责任的护理组织的典范。
