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.
J Am Geriatr Soc. 2024 Nov;72(11):3385-3397. doi: 10.1111/jgs.19141. Epub 2024 Aug 23.
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).
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).
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).
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.
姑息治疗可提高患有绝症的患者的生活质量，而绝症在老年人中很常见。尽管退伍军人事务部（VA）扩大了门诊姑息治疗，但大多数研究都集中在住院姑息治疗上。本研究旨在比较姑息治疗使用者在不同护理环境（住院与门诊）和剂量（姑息治疗次数）下的退伍军人特征和临终关怀使用情况。
本项全国性队列研究纳入了 2014 年至 2017 年间在 VA 接受过任何姑息治疗的退伍军人。我们使用 VA 和医疗保险行政数据（2010-2017 年）来描述退伍军人的人口统计学特征、社会经济地位、绝症、脆弱性和姑息治疗的使用情况。通过诊所停止代码（353、351）和当前程序术语代码（99241-99245）确定专科姑息治疗就诊。
在 4 年内接受过专科姑息治疗的 120249 名退伍军人中，67.8%（n=81523）仅在住院环境中接受过姑息治疗，32.2%（n=38726）至少在门诊环境中接受过一次姑息治疗，无论是否在住院环境中接受过姑息治疗。与住院姑息治疗使用者相比，门诊姑息治疗使用者更有可能患有癌症，而脆弱性较低，但包括农村地区和住房不稳定在内的社会人口因素相似。住院（中位数=37 天；IQR=11，112）和门诊（中位数=44 天；IQR=14，118）姑息治疗使用者的临终关怀使用时间相似，而仅接受一次姑息治疗的使用者的使用时间更短（中位数=18 天；IQR=5，64）。
本项全国性评估提供了有关退伍军人 VA 专科姑息治疗的护理环境和剂量的新见解。在接受姑息治疗的退伍军人中，有三分之一的退伍军人至少在门诊护理环境中接受了一些姑息治疗。住院和门诊使用姑息治疗的退伍军人之间存在差异，这促使人们需要进一步研究，以了解护理环境和姑息治疗次数如何影响退伍军人和老年人的预后。
