Casarett DJ (Center for Health Equity Research and Promotion at the Philadelphia VAMC)
Pickard A (University of Pennsylvania)
MacMoran HJ (University of Pennsylvania)
Shreve S (Lebanon VAMC)
Rosenfeld K (West LA VAMC)
To identify processes of care near the end of life that are unique to the VA and the veteran population, and which have a significant positive or negative impact on the care that veterans and their families receive.
The first development phase of the FATE project utilized qualitative interviews with 45 family members of veterans who received care at 4 VA facilities and at multiple non-VA facilities during the last month of life. Telephone interviews were audiotaped and transcribed, and transcripts were reviewed by 2 coders in a qualitative research software package. Codes were created, refined, and merged to produce a final list of elements of end-of-life care and to define those that are unique to the VA.
Unique problems of end-of-life care identified were grouped in 4 domains: limited access to care (e.g. obstacles to hospice enrollment), inadequate services (e.g. co-practice barriers to medication availability), VA-specific discontinuity of care (e.g. loss of contact with VA primary care provider) and VA benefits (e.g. payment for non-VA medical services). Several other aspects of care were identified that, although not unique to the VA, were common in these interviews but are not included in existing retrospective assessment instruments. These included concerns about inadequate staffing, and suspicions that a family member did not receive all necessary treatment because of rationing of health care in the VA.
There are several domains of care that are unique to veterans near the end of life, and several other domains that may be more important in the VA than in the general population.
There are multiple aspects of end-of-life care that are unique to the VA, and which should be included in a national measure of the quality of care that the VA provides to veterans with chronic, serious illness.