Lorenz K, Yano E, Asch S, Ettner S, Lynn J, Rubenstein L; AcademyHealth. Meeting (2003 : Nashville, Tenn.).
Abstr AcademyHealth Meet. 2003; 20: abstract no. 804.
VA Greater Los Angeles, Palliative Care / General Internal Medicine, 11301 Wilshire Blvd, Code 111-G, Los Angeles, CA 90073 Tel. (310) 478-3711 x43523 Fax (310) 268-4933
RESEARCH OBJECTIVE: Veterans are eligible to use both VA and non-VA services, so achieving better end-of-life care requires evaluating how veterans use non-VA healthcare at the end of their lives. We set out to evaluate veteran characteristics associated with utilizing non-VA care at the end of life and that are associated with site of death. STUDY DESIGN: Using the BIRLS file linked to NPCD data, we identified all veteran decedents who had died in FY2000 and had used VA healthcare in the year prior to death. By linking this data to California Death Certificate data, we determined whether or not veterans died under VA care (home/ VA /non-VA) and site of death (home/inpatient/ER/nursing home). Preliminary multinomial logit models, adjusted for age, race, and gender. POPULATION STUDIED: All FY200 California veteran decedents who were VA healthcare users in the year prior to death. PRINCIPAL FINDINGS: 5244 / 6054 veteran decedent records were linkable to California death certificates. The cohort ethnicity was 74% white,16% African-American,8% Hispanic,2% Asian. 5120 / 5244 decedents were female. Average age was approximately 72 years. Veteran site of death was home for 21%, hospital inpatient for 43%, ER for 8%, and nursing home for 24%. Almost 49% of veteran decedents died while receiving care from non-VA providers. In preliminary models, African-American (B=-0.39,p<0.001) compared to white and older patients were more likely to die in non-VA settings than home (B=-0.02, p<0.001) or VA settings (B=-0.01,p<0.001). Older (B=0.02,p<0.001) and female (B=0.73, p<0.001) patients were more likely to die in long term care than inpatient settings. African-American (B=-0.33,p=0.002) and Hispanic (B=-0.49,p=0.001) patients were less likely to die at home than inpatient settings compared to whites. Black patients (B=0.34,p=0.013) were more likely to die in emergency rooms than inpatient settings compared to whites, and hispanics (B=-0.64,p<0.001) were less likely to die in nursing homes than inpatient settings compared to whites. CONCLUSIONS: The proportion of decedent veterans dying in inpatient settings exceeds that of the proportion of Medicare recipients who die in inpatient settings in California. Older nonwhite patients are more likely to die in non-VA settings or more acute settings. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: There is potential for the VA to improve the management of the terminal experience of veterans, especially nonwhite, older veterans who are most at risk of dying in inpatient, non-VA settings.
Publication Types:
Keywords:
- African Americans
- African Continental Ancestry Group
- California
- Ethnic Groups
- European Continental Ancestry Group
- Female
- Hispanic Americans
- Hospitals, Veterans
- Humans
- Inpatients
- Logistic Models
- Medicare
- Nursing Homes
- Palliative Care
- Terminal Care
- Veterans
- economics
- hsrmtgs
Other ID:
UI: 102275772
From Meeting Abstracts