• Hien Lu, Emily Trancik, F Amos Bailey, Christine Ritchie, Kenneth Rosenfeld, Scott Shreve, Christian Furman, Dawn Smith, Catherine Wolff, and David Casarett.
• Division of Geriatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
• J Palliat Med. 2010 Aug 1;13(8):991-6.

BackgroundThe 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.DesignRetrospective 32-item telephone surveys were conducted with family members of patients who died in VA and non-VA facilities.SettingFive Veterans Affairs medical centers and their affiliated nursing homes and outpatient clinics.ParticipantsPatients 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.ResultsIn 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).ConclusionFamilies 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.

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