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Care of Veterans with Life-Limiting Diagnoses Demonstration and Evaluation

Guihan ML, Granadillo O, LaVela S, Leland J, Weaver FM. Care of Veterans with Life-Limiting Diagnoses Demonstration and Evaluation. Paper presented at: VA National Pain Management Conference; 1999 Nov 3; Alexandria, VA.


Using funding from Dr. Kizer's New Program Initiative, 'Care of Veterans with Life Limiting Illnesses' began demonstration project at the James A. Haley VAMC to expand the Home Based Primary Care (HBPC) Program which expanded their population to include end-stage CHF and COPD patients. Over the past year, the Tampa group, in collaboration with the HSRandD Field Program at Hines, has also developed and implemented an evaluation component. The evaluation study is designed as a single site randomized pretest/post test control group design. Eligible subjects are randomized to either control or treatment conditions. Subjects in the treatment group receive health care services focusing on end of life care coordinated and managed by the Home Based Primary Care (HBPC). Control group subjects will receive VA customary care. VA health care utilization for the 12-month period prior to enrollment in the HBPC program will be collected. These same subjects will be followed for a 12-month period following randomization. Outcomes of interest include health care use and cost, satisfaction with care, health-related quality of life, and management of symptoms. Outcomes will be assessed at baseline, 3 and 12 months following randomization. Because this evaluation is designed as a pilot study, we expect to be able to recruit a total of at least 60 veterans by the end of the first year. In our presentation, we will discuss issues including the development of appropriate inclusion/exclusion criteria for treating thesepopulations; how well these criteria fit with the VA's and Medicaring's definitions of 'end-of-life;' how best to identify these patients and special considerations for collecting data from and providing care for these non-traditional end-of-life patients.

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