Peer Review Articles on Elderly Veterans and Hospice

Introduction

Palliative intendance (PC) is associated with improved quality of life and decreased symptom burden for patients.¹ Notwithstanding, PC is under-resourced and does non consistently meet the needs of patients suffering from serious illness and their families.ⁱⁱ Considerable variation exists in the availability, utilization, and quality of PC, which limits the potential benefits to patients and their families.^3–six Underuse of PC also contributes to high-intensity low-quality medical care received past many patients at the finish of life^7–ten that may not be consistent with their wishes or values.¹¹ Furthermore, the fee-for-service health intendance payment model is common in the Usa and may contribute to burdensome high-intensity care at the stop of life by incentivizing quantity and not quality of care,^12,13 as regional differences in physicians' practices are partially attributable to the availability of high-intensity health care.^xiv

In addition, important barriers to PC uptake include the lack of clinician knowledge of available resources and inadequate grooming in PC.^xiv,fifteen Indeed, clinicians' practise patterns reverberate their local environment or "culture," as evidenced by multiple studies demonstrating that clinicians who work in areas of college density health care services are more reliant on these resource with decreased emphasis on PC.^{three,7,16–19} In response to these shared challenges to the provision of high-quality PC across the US, the Department of Veterans Thing'southward (VA) implemented structure and process changes that provide key insights and a possible path forrad for the broader U.S. wellness care organization.

Construction and Process Changes

Recognizing the increased needs of an aging multimorbid veteran population and the underutilization of PC,^twenty VA committed significant resources to develop, aggrandize, and amend its PC capabilities over the past two decades (Fig. 1). The main goals of these efforts were to improve access to and the resultant quality of end-of-life care among veterans by developing and expanding program structure, defining processes of care, and initiating organisation-wide quality outcome measurements.

FIG. 1. VA timeline for the development of palliative and hospice care programme construction. Over the past xx years, VA has devoted meaning resources to the development and expansion of veterans' access to palliative care and hospice services. Beginning in 2001 with the development of the VAHPC and most recently with the Life Sustaining Treatment Decision Initiative in 2017 to enhance educating clinicians on conducting goals-of-care discussions and ensuring patients' goals, values, and preferences are elicited and documented in the electronic medical record. VAHPC, VA Hospice and Palliative Care Initiative.

To atomic number 82 these efforts, VA established the hospice and palliative care initiative (VAHPC), which included the National Hospice–Veteran Partnership Program, and their Hospice and Palliative Intendance Program Function (Table 1). As part of this initiative, VA mandated that every medical center (hubs in their spoke-hub model) has an inpatient PC squad providing clinical services to veterans and their families.²⁰ With generous funding from congress and partnerships with experts in the field including the Center to Advance Palliative Care (CAPC), VitalTalk^®, and the Education in Palliative and Terminate-of-life Intendance (EPEC) program, VA implemented its Comprehensive Terminate-of-Life Care (CELC) initiative. This initiative also included offset-upwards funding for multidisciplinary PC team members and the creation of the Veteran Experience Center (VEC).²¹ The VEC tracks and collects information most intendance outcomes and satisfaction amid bereaved family members and caregivers using validated surveys that have evolved over time. Initially, the Family Assessment of Handling at End-of-life (FATE) survey²² was adult and piloted for this purpose. Later, the FATE was replaced by the Bereaved Family Survey (BFS) that is endorsed as an stop-of-life quality measure by the National Quality Forum.²³

**Tabular array ane. Veterans Affairs Palliative Care and Hospice Plan Advances in Chronological Order of Implementation**
Program/initiative	Clarification
Hospice and Palliative Care Initiative (VAHPC)	Established a hospice and palliative care program office including programme leadership at the national and medical heart levels
National Hospice-Veteran Partnership Program	Evolution of community partnerships between VA facilities and nonprofit national palliative or coordinated care organizations
Habitation Health and Hospice Care Reimbursement Initiative	Expanded availability and reimbursement of home health and hospice services past partnering with an expanded network of community programs and service providers, including services offered in home settings
Comprehensive Finish-of-Life Intendance Initiative	Established funding for interprofessional palliative care squad members (pharmacists, psychologists, etc.) at each medical eye Creation of the Veteran Experience Middle to monitor plan outcomes Palliative care grooming for clinical leaders and infirmary staff members, and institution of inpatient hospice units Implementation of the Family unit Cess of Treatment at Stop-of-life survey (FATE), then the Bereaved Family Survey (BFS)
Life Sustaining Treatment Decision Initiative	Increase goals of care and advance care planning by educating clinicians on conducting goals-of-care discussions Electronic health record standardized template was adult to document initial and follow-upwardly conversations

Importantly, nether the VA hospice program, veterans are able to receive concurrent medical and hospice care without the cessation of illness-modifying therapies—a unique feature that is not currently available in the Medicare Hospice Do good.²⁴ The power to receive medical care concurrent with hospice may contribute to higher quality,^25,26 although results are mixed.²⁷ Concurrent care may eliminate the "terrible choice" between patients' common desires for both quantity and quality of life,²⁸ potentially removing a barrier to early on hospice enrollment that is associated with improved symptom burden and quality of life.²⁹ Based on this concurrent care model within VA, the Heart for Medicare & Medicaid Services is testing a demonstration project, Medicare Intendance Choices Model, evaluating whether hospice intendance provided in conjunction with other medical services tin improve quality of life, increase patient satisfaction, and decrease expenditures.^xxx

Finally, VA initiated a policy chosen the Life Sustaining Treatment Decision Initiative, focused on educating clinicians on conducting goals-of-intendance discussions ensuring patients' goals, values, and preferences are elicited and documented in the electronic medical record using standardized tools across the continuum of care.³¹ Clinicians (physicians, advance do providers, nurses, social workers, chaplains, etc.) are offered comprehensive training communication sessions based on Vitaltalk, an prove-based communication skills plan.³² In the first seven months of implementation across 137 VA facilities, ∼225,000 Life Sustaining Handling Decision Initiative note templates were completed and entered into VA electronic health tape for ∼110,000 unique veterans.³³ The initiative continues to expand and has now been implemented in 141 VA medical centers with ∼308,000 documented initial goals-of-care conversations per program information reports.

Results of VA System-Wide Improvements: Outcomes

Increased availability and access

Every bit recently as xx years ago, veterans had limited access to both palliative and hospice care. For example, in 2000, 38% of VA medical centers had inpatient PC programs, and only 5% of Veteran decedents received hospice care²⁰ compared to ∼22% among Medicare decedents.⁹ With the institution of the VAHPC and its associated structural and procedure changes, access to palliative and hospice intendance across VA has significantly improved. For instance, a recent study found that hospice apply amongst veteran decedents aged ≥65 years old increased by 7.6% between 2007–2008 and 2010–2014, compared with an increase of merely 5.6% amongst Medicare decedents during that same time period.³⁴ Similarly, the number of inpatient veteran decedents who received PC consultation increased from 29% in 2003 to 46% in 2006.²⁰ Over this aforementioned menstruation, the percentage of inpatient deaths occurring in hospice beds in VA almost tripled from 8% to 22%.^xx Amongst veterans with advanced lung cancer who were recommended to receive timely PC according to the American Gild of Clinical Oncology guidelines,³⁵ one written report constitute a 42% relative increase in PC receipt from 2007 to 2013 within VA.³⁶ However, in non-VA settings, underutilization of PC remains a persistent challenge.³⁷

Site of death

Congruence between preferred and actual place of death is an of import aspect of quality finish-of-life care. Although the bulk of patients and families overwhelmingly prefer to die at abode rather than in a hospital,³⁸ ∼30% of Americans use the intensive care unit of measurement (ICU) in the last calendar month of life.⁹ PC is one tool that can assist align patients' treatment preferences with the intendance they actually receive. For case, among patients with advanced phase lung cancer, 1 study found that PC receipt was associated with a 43% reduced take chances of death in an astute care hospital setting at the end of life compared with nonreceipt of PC.³⁶ Specifically inside VA, improved access to PC through the initiatives described above likely improved congruence between patients' preferred and actual place of death. For instance, 1 study found that veteran decedents who died in VA facilities were more than probable to die in a defended PC or hospice unit rather than existence admitted to an acute care unit compared with those who died in non-VA facilities (47% vs. 16%, respectively).⁴⁰ In that same written report, families of veteran decedents who died in VA compared with non-VA facilities had significantly higher mean satisfaction scores on the FATE survey, indicating ameliorate quality of care at the stop of life.⁴⁰ This college satisfaction likely reflects increased access to PC services and dedicated hospice units within VA.

High-intensity treatment at the end of life

There is a growing trunk of testify that the intensity of treatment received at the end of life is lower among veterans than amongst matched Medicare beneficiaries. For example, a recent study compared intensity of handling received amid veterans diagnosed with advanced colorectal or lung cancer between 2001 and 2002 with propensity-matched patients in fee-for-service Medicare. Authors found that Medicare beneficiaries were more probable to receive chemotherapy within xiv days of death (vii.5% vs. 4.six%) or exist admitted to an ICU within 30 days of expiry (xix.seven% vs. 12.5%) compared with veterans.⁴¹ Similarly, another study of veterans with solid tumors who died between 2010 and 2014 compared intensity of treatment received among those who exclusively used VA services and those who were Medicare -reliant for their care in the last 30 days of life.⁴² Authors plant that Medicare beneficiaries were more likely to take received chemotherapy (adapted odds ratio [aOR] = one.73; confidence interval [95% CI]: ane.68–1.88), be admitted to an ICU (aOR = one.43; 95% CI: 1.36–1.49), be hospitalized (aOR = one.12; 95% CI: 1.09–1.xvi), or have experienced an in-infirmary death (aOR = 1.19, 95% CI: 1.13–1.24) compared with veterans who were not reliant on Medicare.⁴² Furthermore, amongst veterans with advanced phase lung cancer, PC was associated with reduced health care utilization including emergency department visits (adjusted incidence charge per unit ratio [aIRR] = 0.86, 95% CI: 0.77–0.96), hospitalizations (aIRR = 0.64, 95% CI: 0.59–0.70, and ICU admission [aOR] = 0.63, 95% CI: 0.53–0.75).³⁹ Taken together these studies suggest that VA'due south palliative and end-of-life care initiatives may take helped reduce high-intensity care at the stop of life that is consistently lower than comparable Medicare beneficiaries.

Bereaved families' perceptions of care

Equally role of the CELC initiative, surveys are administered to veterans' families or caregivers when veterans pass away in VA facilities. These surveys consistently demonstrate that families who receive PC and hospice services at VA report significantly higher quality of intendance.²² For example, families of veterans who died in a PC unit had significantly higher mean FATE scores than families of veterans who died in other inpatient settings.⁴³ Families of veterans with end-stage renal disease^44,45 or middle failure⁴⁶ who concurrently received PC and/or hospices services were as well more than probable to rate overall quality of terminate-of-life care better, through the BFS, compared with those families of patients who did not receive these services. Finally, before receipt of PC in the disease trajectory is associated with improved quality of end-of-life care as perceived past patients and their families. For example, 1 written report found that families of decedent veterans were more than likely to rate overall care as "excellent" on the BFS when the PC consult occurred 91–180 days before expiry, compared with those whose PC consult occurred 0–7 days before death (aOR = one.37, 95% CI: 1.08–1.73).⁴⁷

Lessons for the Future

The strategic implementation and expansion of PC and hospice services that VA undertook have increased accessibility to services with improvements in patients' and families' experiences and reduced emphasis on burdensome low-quality intendance at the end of life, although, from the bachelor evidence, these benefits are by and large demonstrated among veterans with cancer. Despite significant patient and family benefits, there are several potential reasons why widespread adoption of VA's PC structure and process changes has not occurred in not-VA settings.

First, similar to many health care policy changes, these initiatives occurred outside of a enquiry framework, therefore, attributing specific changes to improved outcomes is challenging. Therefore, if similar programs are initiated in non-VA settings, at that place is meaning potential for pragmatic or adaptive study designs to ameliorate discern outcomes and event sizes. Second, programme and leadership structure within VA have probable influenced local culture including clinicians' beliefs and practice patterns within the organisation,⁴⁸ which are known to be cardinal drivers of the delivery and quality of end-of-life intendance,^{fourteen,49,50} just may be difficult to replicate in other settings. A acme-down arroyo to PC implementation including developing a programme role to support initiatives and local leadership probable affected local institutional civilisation and disentangling the effects of structure or process changes versus institutional culture change is problematic. Finally, as an integrated wellness care system, VA can more easily influence care through the hiring of clinicians and other professionals, implementation of PC didactics or preparation for nurses, dissemination of institutional guidelines, and application of guidelines through local leadership. A national strategy to improve PC commitment has been suggested⁵¹ and many of VA's programs and initiatives are scalable and deserve consideration for broader implementation in non-VA settings.

Several components of VA'south programs may be more readily implementable. Showtime, VA's experience in PC program development included emphasis on robust program infrastructure that supports program capacity, implementation, and sustainability. This infrastructure needs to include local programme leadership who are able to promote, coordinate, and champion activities and initiatives including PC teaching for non-PC clinicians. Second, VA serves every bit a model for an interprofessional arroyo that is well suited to the do of PC, as teams address multiple domains in caring for patients with serious affliction including physical, psychological, social, and spiritual.^52,53 Third, the creation of the VEC to monitor patient outcomes, with regular feedback to forepart-line PC staff, is an essential component of procedure comeback and is increasingly existence implemented by health care organizations outside of PC disciplines.⁵⁴ Finally, the benefits of an integrated health care organisation where outpatient, acute care, rehabilitation, and inpatient hospice services share a mutual payer, electronic medical tape, and infrastructure are likely central to improved outcomes among veterans as care coordination is a core domain of quality PC.⁵²

Despite the potential benefits afforded by the VA system in the provision of quality care amongst those with serious affliction, major shifts in the financing of care are occurring, including recommendations that VA shift from a capitation-based organisation to an increasingly Medicare-like role in purchasing intendance in non-VA settings.⁵⁵ If this occurs, the question that arises is whether intendance commitment and quality will be ameliorate than the current VA system, studies suggest this will non be the case.^42,56 Fee for service is the near mutual payment model that serves nearly Americans with serious illness and this model may incentivize clinicians and hospitals to render more intensive services than are beneficial at the end of life.^57,58 Addressing the financial incentives of fee-for-service care is disquisitional to health care reform efforts,^59,60 and shifting payment from a service-based to a value-based model could emphasize patient preferences and better the quality of cease-of-life care. Finally, moving abroad from an integrated wellness care arrangement to become a purchaser of care, VA would likely experience the same negative effects of fragmented care that plague patients, clinicians, and hospitals in nonintegrated health care systems,^61–63 which may be particularly harmful for the delivery of quality PC. Although opportunities for comeback and research gaps be within VA'southward framework, their PC plan structure, processes, and policies deserve broader attention toward improving the quality of care among persons with serious illness.

Authors' Contributions

All authors made substantial contributions to this commodity based on the International Committee of Medical Periodical Editors criteria.

Acknowledgments

We thank Dr. Kelly Vranas for her editing of earlier versions of this commodity. The content is solely the responsibleness of the authors and does not necessarily represent the official views of the National Institutes of Wellness. The Department of Veterans Affairs did not have a role in the conduct of the report, in the collection, management, analysis, interpretation of data, or in the grooming of the article.

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Funding Information

D.R.South. was funded through the Sojourns Scholar Leadership Programme Award of the Cambia Health Foundation.

Author Disclosure Statement

No competing financial interests exist.

References

1. Kavalieratos D, Corbelli J, Zhang D, et al. : Clan between palliative care and patient and caregiver outcomes: A systematic review and meta-analysis. JAMA 2016;316:2104–2114. Crossref, Medline, Google Scholar
2. America's Care of Serious Disease: A Country-by-State Study Card on Access to Palliative Care in Our Nation'south Hospitals . Centre to Advance Palliative Care and the National Palliative Intendance Inquiry Center, September 2019. Google Scholar
iii. Institute of Medicine: Variation in Health Care Spending: Target Decision Making, Not Geography . Washington DC: National Academies Printing, 2013. Google Scholar
4. Hawley P: Barriers to access to palliative care. Palliat Care 2017;10:1178224216688887. Google Scholar
five. Kruser JM, Aaby DA, Stevenson DG, et al. : Assessment of variability in end-of-life care delivery in intensive care units in the United States. JAMA Netw Open 2019;ii:e1917344. Crossref, Medline, Google Scholar
6. Huo J, Hong Yr, Turner K, et al. : Geographic variation in palliative care commitment amidst patients diagnosed with metastatic lung cancer in the USA: Medicare population-based study. Support Intendance Cancer 2021;29:813–821. Crossref, Medline, Google Scholar
7. Goldsmith B, Dietrich J, Du Q, Morrison RS: Variability in access to infirmary palliative care in the United States. J Palliat Med 2008;11:1094–1102. Link, Google Scholar
8. Spetz J, Dudley North, Trupin 50, et al. : Few hospital palliative intendance programs meet national staffing recommendations. Health Aff (Millwood) 2016;35:1690–1697. Crossref, Medline, Google Scholar
9. Teno JM, Gozalo P, Trivedi AN, et al. : Site of death, place of care, and health care transitions among US Medicare beneficiaries, 2000–2015. JAMA 2018;320:264–271. Crossref, Medline, Google Scholar
10. Fisher ES, Wennberg DE, Stukel TA, et al. : The implications of regional variations in Medicare spending. Part 1: The content, quality, and accessibility of care. Ann Intern Med 2003;138:273–287. Crossref, Medline, Google Scholar
11. Wright AA, Keating NL, Ayanian JZ, et al. : Family unit perspectives on aggressive cancer care about the terminate of life. JAMA 2016;315:284–292. Crossref, Medline, Google Scholar
12. Zuvekas SH, Cohen JW: Fee-for-service, while much maligned, remains the ascendant payment method for physician visits. Health Aff (Millwood) 2016;35:411–414. Crossref, Medline, Google Scholar
13. Burwell SM: Setting value-based payment goals—HHS efforts to better U.S. health care. N Engl J Med 2015;372:897–899. Crossref, Medline, Google Scholar
xiv. Keating NL, Huskamp HA, Kouri Eastward, et al. : Factors contributing to geographic variation in stop-of-life expenditures for cancer patients. Health Aff (Millwood) 2018;37:1136–1143. Crossref, Medline, Google Scholar
15. Obermeyer Z, Powers BW, Makar M, et al. : Physician characteristics strongly predict patient enrollment in hospice. Health Aff (Millwood) 2015;34:993–1000. Crossref, Medline, Google Scholar
16. Kelley AS, Ettner SL, Morrison RS, et al. : Determinants of medical expenditures in the last 6 months of life. Ann Intern Med 2011;154:235–242. Crossref, Medline, Google Scholar
17. Kogan Air conditioning, Brumley R, Wilber K, Enguidanos S: Physician factors that influence patient referrals to terminate-of-life care. Am J Manag Care 2012;18:e416–e422. Medline, Google Scholar
xviii. Stelfox HT, Hemmelgarn BR, Bagshaw SM, et al. : Intensive care unit of measurement bed availability and outcomes for hospitalized patients with sudden clinical deterioration. Arch Intern Med 2012;172:467–474. Crossref, Medline, Google Scholar
19. Wang SY, Hall J, Pollack CE, et al. : Associations between cease-of-life cancer care patterns and Medicare expenditures. J Natl Compr Canc Netw 2016;fourteen:1001–1008. Crossref, Medline, Google Scholar
20. Edes T, Shreve South, Casarett D: Increasing admission and quality in Department of Veterans Affairs care at the stop of life: A lesson in modify. J Am Geriatr Soc 2007;55:1645–1649. Crossref, Medline, Google Scholar
21. Department of Veterans Affairs: Hospice and Palliative Care 2011 Almanac Study . Washington DC: VHA, 2011. Google Scholar
22. Casarett D, Pickard A, Bailey FA, et al. : A nationwide VA palliative intendance quality measure: The family assessment of treatment at the finish of life. J Palliat Med 2008;11:68–75. Link, Google Scholar
23. National Quality Forum (NQF): Preferred Practices and Functioning Measures for Measuring and Reporting Care Coordination: A Consensus Written report . Washington, DC: NQF, 2010. Google Scholar
24. Aldridge Carlson Doc, Barry CL, Cherlin EJ, et al. : Hospices' enrollment policies may contribute to underuse of hospice care in the United States. Health Aff (Millwood) 2012;31:2690–2698. Crossref, Medline, Google Scholar
25. Mor V, Joyce NR, Cote DL, et al. : The rise of concurrent care for veterans with avant-garde cancer at the end of life. Cancer 2016;122:782–790. Crossref, Medline, Google Scholar
26. Mor V, Wagner TH, Levy C, et al. : Association of expanded VA hospice care with aggressive care and cost for Veterans with advanced lung cancer. JAMA Oncol 2019;5:810–816. Crossref, Medline, Google Scholar
27. Presley CJ, Han L, O'Leary JR, et al. : Concurrent hospice care and cancer-directed treatment for advanced lung cancer and receipt of aggressive care at the end of life in the Veteran'due south Health Administration. J Palliat Med 2020;23:1038–1044. Link, Google Scholar
28. Casarett DJ, Fishman JM, Lu HL, et al. : The terrible pick: Re-evaluating hospice eligibility criteria for cancer. J Clin Oncol 2009;27:953–959. Crossref, Medline, Google Scholar
29. Currow DC, Agar MR, Phillips JL: Role of hospice care at the stop of life for people with cancer. J Clin Oncol 2020;38:937–943. Crossref, Medline, Google Scholar
xxx. U.S. Centers for Medicare & Medicaid Services: The CMS Innovation Center. www.innovation.cms.gov (Last accessed July 27, 2021 ). Google Scholar
31. Foglia MB, Lowery J, Sharpe VA, et al. : Comprehensive approach to eliciting, documenting, and honoring patient wishes for care near the end of life: The Veterans Health Administration's Life-Sustaining Treatment Decisions Initiative. Jt Comm J Qual Patient Saf 2019;45:47–56. Crossref, Medline, Google Scholar
32. Dorsum AL, Fromme EK, Meier DE: Training clinicians with advice skills needed to match medical treatments to patient values. J Am Geriatr Soc 2019;67:S435–S441. Crossref, Medline, Google Scholar
33. Levy C, Ersek Yard, Scott W, et al. : Life-Sustaining Handling Decisions Initiative: Early implementation results of a national Veterans Diplomacy plan to honor Veterans' care preferences. J Gen Intern Med 2020;35:1803–1812. Crossref, Medline, Google Scholar
34. Miller SC, Intrator O, Scott W, et al. : Increasing Veterans' hospice use: The Veterans Wellness Administration'southward focus on improving finish-of-life care. Health Aff (Millwood) 2017;36:1274–1282. Crossref, Medline, Google Scholar
35. Ferrell BR, Temel JS, Temin S, et al. : Integration of palliative care into standard oncology care: American Club of Clinical Oncology clinical practice guideline update. J Clin Oncol 2017;35:96–112. Crossref, Medline, Google Scholar
36. Sullivan DR, Chan B, Lapidus JA, et al. : Association of early on palliative care use with survival and place of death amid patients with advanced lung cancer receiving care in the Veterans Health Assistants. JAMA Oncol 2019;five:1702–1709. Crossref, Medline, Google Scholar
37. Rayburn JR, Wilshire CL, Gilbert CR, et al. : PS02.04 Palliative care and hospice resource are underutilized in patients with advanced non-small jail cell lung cancer: Topic: Medical oncology. J Thorac Oncol 2017;12:S1565. Crossref, Google Scholar
38. Murray MA, Fiset Five, Young South, Kryworuchko J: Where the dying live: A systematic review of determinants of identify of terminate-of-life cancer intendance. Oncol Nurs Forum 2009;36:69–77. Crossref, Medline, Google Scholar
39. Vranas KC, Lapidus JA, Ganzini L, et al. : Association of palliative care use and setting with wellness-care utilization and quality of care at the finish of life amid patients with avant-garde lung cancer. Chest 2020;158:2667–2674. Crossref, Medline, Google Scholar
40. Lu H, Trancik E, Bailey FA, et al. : Families' perceptions of stop-of-life care in Veterans Affairs versus non-Veterans Affairs facilities. J Palliat Med 2010;13:991–996. Link, Google Scholar
41. Keating NL, Landrum MB, Lamont EB, et al. : Terminate-of-life care for older cancer patients in the Veterans Health Assistants versus the private sector. Cancer 2010;116:3732–3739. Crossref, Medline, Google Scholar
42. Gidwani-Marszowski R, Needleman J, Mor Five, et al. : Quality of terminate-of-life care is college in the VA compared to intendance paid for by traditional Medicare. Health Aff (Millwood) 2018;37:95–103. Crossref, Medline, Google Scholar
43. Finlay E, Shreve Due south, Casarett D: Nationwide Veterans Diplomacy quality mensurate for cancer: The family assessment of treatment at end of life. J Clin Oncol 2008;26:3838–3844. Crossref, Medline, Google Scholar
44. Richards CA, Liu CF, Hebert PL, et al. : Family unit perceptions of quality of end-of-life intendance for Veterans with advanced CKD. Clin J Am Soc Nephrol 2019;xiv:1324–1335. Crossref, Medline, Google Scholar
45. Richards CA, Hebert PL, Liu CF, et al. : Clan of family ratings of quality of cease-of-life care with stopping dialysis treatment and receipt of hospice services. JAMA Netw Open up 2019;ii:e1913115. Crossref, Medline, Google Scholar
46. Feder SL, Tate J, Ersek Thou, et al. : The association betwixt hospital end-of-life care quality and the care received amidst patients with eye failure. J Pain Symptom Manage 2021;61:713–722.e1. Crossref, Medline, Google Scholar
47. Carpenter JG, McDarby M, Smith D, et al. : Associations betwixt timing of palliative care consults and family evaluation of care for Veterans who die in a hospice/palliative care unit of measurement. J Palliat Med 2017;20:745–751. Link, Google Scholar
48. Cutler D, Skinner J, Stern Advertisement, Wennberg D: Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Wellness Intendance Spending. National Agency of Economical Inquiry Working Paper Series 2013; No. 19320. Google Scholar
49. Keating NL, O'Malley AJ, Onnela JP, et al. : Influence of peer physicians on intensity of terminate-of-life care for cancer decedents. Med Intendance 2019;57:468–474. Crossref, Medline, Google Scholar
fifty. Sirovich B, Gallagher PM, Wennberg DE, Fisher ES: Discretionary conclusion making by principal care physicians and the cost of U.S. health care. Wellness Aff (Millwood) 2008;27:813–823. Crossref, Medline, Google Scholar
51. Meier DE, Back AL, Berman A, et al. : A national strategy for palliative care. Health Aff (Millwood) 2017;36:1265–1273. Crossref, Medline, Google Scholar
52. National Consensus Project for Quality Palliative Care: Clinical Practise Guidelines for Quality Palliative Care, quaternary ed . Richmond, VA: National Coalition for Hospice and Palliative Care, 2018. Google Scholar
53. Sullivan DR, Ganzini L, Delorit MA, et al. : Transcending silos and edifice relationships: A qualitative written report of palliative care use and integration in a national health organisation. Am J Respir Crit Care Med [series online] 2020. [Epub alee of print]; DOI: 10.1164/ajrccm-conference.2020.201.1_MeetingAbstracts.A2820. Crossref, Google Scholar
54. Lilford RJ, Brown CA, Nicholl J: Utilise of procedure measures to monitor the quality of clinical practice. BMJ 2007;335:648–650. Crossref, Medline, Google Scholar
55. Sayre GG, Neely EL, Simons CE, et al. : Accessing intendance through the Veterans Choice Programme: The Veteran experience. J Gen Intern Med 2018;33:1714–1720. Crossref, Medline, Google Scholar
56. Trivedi AN, Matula Due south, Miake-Lye I, et al. : Systematic review: Comparison of the quality of medical care in Veterans Affairs and non-Veterans Affairs settings. Med Care 2011;49:76–88. Crossref, Medline, Google Scholar
57. Constitute of Medicine: Dying in America: Improving Quality and Honoring Private Preferences Most the Stop of Life. Committee on Approaching Death: Addressing Key Cease of Life Bug . Washington DC: National Academies Press, 2015. Google Scholar
58. Morden NE, Chang CH, Jacobson JO, et al. : End-of-life care for Medicare beneficiaries with cancer is highly intensive overall and varies widely. Health Aff (Millwood) 2012;31:786–796. Crossref, Medline, Google Scholar
59. McCain J: Access to quality and affordable health treat every American. N Engl J Med 2008;359:1537–1541. Crossref, Medline, Google Scholar
sixty. Obama B: Mod health care for all Americans. N Engl J Med 2008;359:1537–1541. Crossref, Medline, Google Scholar
61. Health Manufacture Forum: Healthcare payment reform: Creating weather for more efficient wellness delivery. 2008. http://healthforum.brandeis.edu/meetings/materials/2008%twenty-%2010%twenty-%20April/Payment%20Brief%204-10-08_final.pdf (Concluding accessed September 5, 2021 ). Google Scholar
62. Shih A, Davis K, Schoenbaum S, Gauthier A: Organizing the U.South. health care commitment system for high operation. The Commonwealth Fund, 2008. Google Scholar
63. Pereira Gray DJ, Sidaway-Lee K, White E, et al. : Continuity of intendance with doctors-a matter of life and expiry? A systematic review of continuity of care and mortality. BMJ Open 2018;8:e021161. Crossref, Medline, Google Scholar

piercepasuch.blogspot.com

Source: https://www.liebertpub.com/doi/10.1089/jpm.2021.0246