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Publication Briefs

Receiving Hospice Services Improved Ratings of End-of-Life Care for Veterans in VA Home-Based Primary Care

Since 1972, interdisciplinary primary care services have been delivered to Veterans with serious chronic and disabling conditions in their homes through VA’s home-based primary care (HBPC) program. Studies of the relationship between hospice and the quality of end-of-life (EOL) care for HBPC-enrolled Veterans are critically needed, given the overall annual mortality rate of 31%. This retrospective study sought to describe Veterans’ use of community-based hospice services while enrolled in HBPC and their associations with bereaved families’ perceptions of care. Since 2010, VA has elicited bereaved families’ evaluations of care in the last month of life for Veterans dying in inpatient VA facilities using the Bereaved Family Survey (BFS), which is mailed to the deceased Veteran’s next-of-kin (NOK) 4-6 weeks after the Veteran’s death and is completed by mail, phone, or online. Using VA data, including data from the BFS, investigators identified 3,967 Veterans who died in a home, non-VA hospital, or community nursing home while enrolled in VA’s HBPC program – across seven VISNs – between October 2013 and September 2019. The primary outcome in this analysis was the BFS global rating of care received in the last 30 days of life. Investigators also examined patient characteristics (i.e., NOK, demographics, comorbidities, and disability status) and healthcare utilization.


  • Overall, 53% of family members reported that the care received by Veterans receiving HBPC in the last 30 days of life was excellent. Families of Veterans who received hospice services gave higher global ratings of end-of-life care quality than those who did not (56% vs. 47%).
  • The highest scoring secondary BFS outcomes were related to providers always being kind, caring and respectful (87%) and managing PTSD symptoms among Veterans experiencing stress (85%). The lowest scoring items were related to receiving enough information about survivor (38%) and burial and memorial (43%) benefits following the Veteran’s death.
  • On 12 of the 14 secondary BFS outcomes, Veterans who received hospice services scored higher than those that did not.


  • Findings suggest that increased referrals to community hospice partners for qualifying Veterans may result in more favorable perceptions of the overall EOL care experience, particularly as it relates to communication and the provision of emotional and spiritual support.


  • As the BFS was originally validated among inpatient samples, some items may not be interpreted in the same way by families whose Veteran primarily received care at home.
  • Data did not allow investigators to specify the unique services provided by hospice that could account for the observed differences.

Drs. Ersek, Thorpe, and Kutney-Lee are part of HSR&D’s Center for Health Equity, Research and Promotion (CHERP). Dr. Wachterman is part of HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR).

Kinder D, Smith D, Ersek M, Wachterman M, Thorpe J, Davis D, and Kutney-Lee A. Family Reports of End-of-Life Care among Veterans in Home-based Primary Care: The Role of Hospice. Journal of the American Geriatrics Society. September 29, 2021; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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