• Shelli L Feder, Janet Tate, Mary Ersek, Supriya Krishnan, Sarwat I Chaudhry, Lori A Bastian, Joshua Rolnick, Ann Kutney-Lee, and Kathleen M Akgün.
• Yale University School of Nursing, West Haven, Connecticut, USA; VA Connecticut Healthcare System, West Haven, Connecticut, USA. Electronic address: shelli.feder@yale.edu.
• J Pain Symptom Manage. 2021 Apr 1; 61 (4): 713722.e1713-722.e1.

ContextImproving end-of-life care (EOLC) quality among heart failure patients is imperative. Data are limited as to the hospital processes of care that facilitate this goal.ObjectivesTo determine associations between hospital-level EOLC quality ratings and the EOLC delivered to heart failure patients.MethodsRetrospective analysis of the Veterans Health Administration (VA) and the Bereaved Family Survey data of heart failure patients from 2013 to 2015 who died in 107 VA hospitals. We calculated hospital-level observed-to-expected casemix-adjusted ratios of family reported excellent EOLC, dividing hospitals into quintiles. Using logistic regression, we examined associations between quintiles and palliative care consultation, receipt of chaplain and bereavement services, inpatient hospice, and intensive care unit death.ResultsOf 6256 patients, mean age was 77.4 (SD = 11.1), 98.3% were male, 75.7% were white, and 18.2% were black. Median hospital scores of "excellent" EOLC ranged from 41.3% (interquartile range 37.0%-44.8%) in the lowest quintile to 76.4% (interquartile range 72.9%-80.3%) in the highest quintile. Patients who died in hospitals in the highest quintile, relative to the lowest, were slightly although not significantly more likely to receive a palliative care consultation (adjusted proportions 57.6% vs. 51.2%; P = 0.32) but were more likely to receive chaplaincy (92.6% vs. 81.2%), bereavement (86.0% vs. 72.2%), and hospice (59.7% vs. 35.9%) and were less likely to die in the intensive care unit (15.9% vs. 31.0%; P < 0.05 for all).ConclusionPatients with heart failure who die in VA hospitals with higher overall EOLC quality receive more supportive EOLC. Research is needed that integrates care processes and develops scalable best practices in EOLC across health care systems.Published by Elsevier Inc.

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