title: Families' perceptions of end-of-life care in Veterans Affairs versus non-Veterans Affairs facilities.
abstract: BACKGROUND
  The Veterans Affairs (VA) has made significant investments in care for veterans. However, it is not known whether these investments have produced improvements in end-of-life care in the VA compared to other settings. Therefore, the goal of this study was to compare families' perceptions of end-of-life care among patients who died in VA and non-VA facilities.
  
  
  METHODS
  Retrospective 32-item telephone surveys were conducted with family members of patients who died in VA and non-VA facilities.
  
  
  METHODS
  Five Veterans Affairs medical centers and their affiliated nursing homes and outpatient clinics.
  
  
  METHODS
  Patients were eligible if they received any care from a participating VA facility in the last month of life and if they died in an inpatient setting. One family member per patient completed the survey.
  
  
  RESULTS
  In bivariate analysis, patients who died in VA facilities (n = 520) had higher mean satisfaction scores compared to those who died in non-VA facilities (n = 89; 59 versus 51; rank sum test p = 0.002). After adjusting for medical center, the overall score was still significantly higher for those dying in the VA (beta = 0.07; confidence interval [CI] = 0.02-0.11; p = 0.004), as was the domain measuring care around the time of death (beta = 0.11; CI = 0.04-0.17; p = 0.001).
  
  
  CONCLUSIONS
  Families of patients who died in VA facilities rated care as being better than did families of those who died in non-VA facilities. These results provide preliminary evidence that the VA's investment in end-of-life care has contributed to improvements in care in VA facilities compared to non-VA facilities.
authors.affiliation: Division of Geriatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Hien
authors.initials: H
authors.lastname: Lu
authors.forename: Emily
authors.initials: E
authors.lastname: Trancik
authors.forename: F Amos
authors.initials: FA
authors.lastname: Bailey
authors.forename: Christine
authors.initials: C
authors.lastname: Ritchie
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rosenfeld
authors.forename: Scott
authors.initials: S
authors.lastname: Shreve
authors.forename: Christian
authors.initials: C
authors.lastname: Furman
authors.forename: Dawn
authors.initials: D
authors.lastname: Smith
authors.forename: Catherine
authors.initials: C
authors.lastname: Wolff
authors.forename: David
authors.initials: D
authors.lastname: Casarett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003142:Communication; D005190:Family / Q000523:psychology*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011787:Quality of Health Care / Q000458:organization & administration; D012044:Regression Analysis; D012189:Retrospective Studies; D012944:Social Support; D029181:Spirituality; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data