Diagnostic classifications and resource utilization of decedents served by the Department of Veterans Affairs.
BACKGROUND
Given the volume and cost of inpatient care during the last year of life, there is a critical need to identify patterns of dying as a means of planning end-of-life care services, especially for the growing number of older persons who receive services from the Veterans Health Administration (VHA).


METHODS
A retrospective computerized record review was conducted of 20,933 VHA patients who died as inpatients between October 1, 2001 and September 30, 2002. Diagnoses were aggregated into one of five classification patterns of death and analyzed in terms of health care resource utilization (mean number of inpatient days and cumulative outpatient visits in the year preceding the patient's death).


RESULTS
Cancer deaths were the most common (30.4%) followed by end-stage renal disease (ESRD) (23.2%), cardiopulmonary failure (21.4%), frailty (11.6%), "other" diagnoses (7.3%), and sudden deaths (6.1%). Those with ESRD were more likely to be male and nonwhite (p < 0.05) and those with frailty were more likely to be older and married (p < 0.05). Controlling for demographic variables, those with frailty had the highest number of inpatient days while those with ESRD had the highest number of outpatient visits. Non-married status was associated with more inpatient days, especially among younger decedents.


CONCLUSIONS
As a recognized leader in end-of-life care, the VHA can play a unique role in the development of specific interventions that address the diverse needs of persons with different dying trajectories identified through this research.
Duffy
Sonia A
SA
VA Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, Michigan 48113-0170, USA. Sonia.Duffy@va.gov
Copeland
Laurel A
LA
Hopp
Faith P
FP
Zalenski
Robert J
RJ
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends*; D003710:Demography; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000401:mortality; D017051:Hospice Care; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D007676:Kidney Failure, Chronic / Q000401:mortality; D008297:Male; D009369:Neoplasms / Q000401:mortality; D010166:Palliative Care; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs