title: Patterns of hospice care among military veterans and non-veterans.
abstract: BACKGROUND
  Historically, hospice use by veterans has lagged behind that of non-veterans. Little is known about hospice use by veterans at a population level.
  
  
  OBJECTIVE
  To determine whether veteran and non-veteran hospice users differ by demographics, primary diagnosis, location of care, and service utilization.
  
  
  METHODS
  Using the 2007 National Home and Hospice Care Survey, we identified 483 veteran and 932 non-veteran male hospice users representing 287,620 hospice enrollees nationally. We used chi-square and t-tests to compare veterans and non-veterans by demographic characteristics, primary diagnosis, and location of hospice care. We used multivariate regression to assess for differences in hospice diagnosis and location of care, adjusting for demographic and clinical factors. We also compared length of stay and number of visits by hospice personnel between veterans and non-veterans using multivariate regression.
  
  
  RESULTS
  Veteran hospice users were older than non-veterans (77.0 vs. 74.3 years, P = 0.02) but did not differ by other demographics. In adjusted analyses, cancer was a more common primary diagnosis among veterans than non-veterans (56.4% vs. 48.4%; P = 0.02), and veteran hospice users were more likely than non-veterans to receive hospice at home (68.4% vs. 57.6%; P = 0.007). The median adjusted length of stay and number of nurse or social worker visits did not differ by veteran status (all P > 0.10), but veterans received fewer home health aide visits than non-veterans (one every 5.3 days vs. one every 3.7 days; P = 0.002).
  
  
  CONCLUSIONS
  Although veteran and non-veteran hospice users were similar on most demographic measures, important differences in hospice referral patterns and utilization exist.
authors.affiliation: Section of General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: melissa.wachterman@va.gov.
authors.forename: Melissa W
authors.initials: MW
authors.lastname: Wachterman
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.affiliation: Section of General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
authors.affiliation: Division of General Internal Medicine and Division of Palliative Care, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006699:Home Care Services / Q000706:statistics & numerical data; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology; D014728:Veterans
keywords: Hospice; clinical case mix; demographics; health care utilization; nationally representative data; veterans