A nationwide VA palliative care quality measure: the family assessment of treatment at the end of life.
OBJECTIVE
To evaluate the FATE (Family Assessment of Treatment at End of Life) Survey for use as a nationwide quality measure in the VA health care system.


METHODS
Nationwide telephone survey.


METHODS
Five VA medical centers.


METHODS
Eligible patients received inpatient or outpatient care from a participating VA facility in the last month of life. One respondent/patient was selected using predefined eligibility criteria and invited to participate.


METHODS
The FATE survey consists of 32 items in 9 domains: Well-being and dignity (4 items), Information and communication (5 items), Respect for treatment preferences (2 items), Emotional and spiritual support (3 items), Management of symptoms (4 items), Choice of inpatient facility (1 item), Care around the time of death (6 items), Access to VA services (4 items), and Access to VA benefits after the patient's death (3 items).


RESULTS
Interviews were completed with 309 respondents. The FATE showed excellent psychometric characteristics, with good homogeneity (e.g., Cronbach (alpha = 0.91) and no evidence of significant ceiling effects. The FATE also demonstrated good discriminant validity. For instance, FATE scores varied across facilities (range 44-72; Kruskal Wallis test p < 0.001). Patients who were seen by a palliative care service had better scores (mean 66 versus 52; rank sum test p < 0.001), as did patients who were referred to hospice (67 versus 49; rank sum test p < 0.001).


CONCLUSIONS
The FATE survey offers an important source of quality data that can be used to improve the end-of-life care of all veterans, regardless of the type of care they receive or their site of death.
Casarett
David
D
Center for Health Equity Research and Promotion, Philadelphia VAMC, Philadelphia, Pennsylvania, USA. Casarett@mail.upenn.edu
Pickard
Amy
A
Bailey
F Amos
FA
Ritchie
Christine Seel
CS
Furman
Christian Davis
CD
Rosenfeld
Ken
K
Shreve
Scott
S
Shea
Judy
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003258:Consumer Behavior; D005190:Family / Q000523:psychology*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards*; D011787:Quality of Health Care; D013727:Terminal Care; D014481:United States