VA and Non-VA End-of-Life Care: Results of a Randomized Multisite Trial

Weaver FM, Hughes S, Giobbie-Hurder AG. VA and Non-VA End-of-Life Care: Results of a Randomized Multisite Trial. Paper presented at: Gerontological Society of America Annual Scientific Meeting; 2001 Nov 1; Chicago, IL.

Terminall ill veterans (MD prognosis < 6 months) were randomized to receive home based primary care (HBPC) provided by VA or customary care. 401 terminally ill veterans were recruited from 16 VA hospitals. Patients and their informal caregivers were followed for 1 year to asess ADLs, satisfaction with care, health-related quality of life (HRQL) and caregiver burden at 1, 6 and 12 months. Health care utilization and costs were tracked for the same period. One-third of the sample was under age 65. 85% of HBPC subjects received services, whereas 41% of customary care sujbects used Medicare home care. 7% of HBPC and 21% of customary care subjects used hospice. HBPC subjects had significantly higher HRQL on 6 of 8 subscales of the SF-36 than customary care. Caregiver satisfaction with care and HRQL also were higher in the HBPC group. HBPC patients were followed for 167 days, on average, while Medicare home care received care for 101 days and hospice averaged 47 days. Average total health care costs did not differ by group ($21087 for HBPC v. $19196 for customary care; p = 0.36). VA HBPC provided care to terminal veterans that was of longer duration, comparable cost with higher HRQL outcomes than customary care.