A retrospective study of deceased veterans with serious mental illness and heart failure: Analysis of palliative care and mental health collaboration on hospice utilization

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry Pub Date : 2025-07-13 DOI:10.1016/j.genhosppsych.2025.07.009

Jaclyn Boozalis , Jaclyn Perreault , Helen I. Turner , Wen-Chih Wu , Julia Browne , Lan Jiang , Mitchell Wice , James L. Rudolph , Jensy P. Stafford

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Abstract

Introduction

Serious Mental Illness (SMI) adds complexity to end of life care including medical decision making. For complex patients, enrollment in team-based hospice care providescoordinated services and supports. This retrospective study evaluated if the combinations of mental health care or palliative care increased hospice enrollment in the last 6 months of life.

Methods

We identified deceased Veterans with diagnoses of heart failure (HF) and SMI. SMI was defined as schizophrenia spectrum or bipolar spectrum disorder. We categorized the SMI population into 4 groups: those with mental health and palliative care (n = 2973), only mental health (n = 4333), only palliative care (n = 892), or neither (n = 1171). The outcome of hospice use in the 6-months before death was measured with VA and Medicare records. Logistic regression compared the mental health and palliative care groups to the reference group and included adjustment for demographics and comorbidities.

Results

The cohort included 9369 Veterans with HF and SMI who died between 2011 and 2020. Relative to the reference group (23.9 % hospice), those with mental health engagement had lower odds of receiving hospice (adjusted Odds Ratio (aOR) = 0.74; 95 % confidence interval (CI) 0.62,0.87). Exposure to palliative care increased the adjusted odds of hospice in those with mental health services (aOR = 6.67, 95 % CI 5.61, 7.92) and with only palliative care (aOR = 5.96, 95 % CI 4.86, 7.32).

Conclusion

This study demonstrates a gap in hospice enrollment for people with SMI. Palliative care improves the gap. Increased collaboration between mental health and palliative providers and cross-training may improve the experience of people with SMI.

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退伍军人严重精神疾病和心力衰竭的回顾性研究：姑息治疗和心理健康合作对安宁疗护利用的分析

严重精神疾病（SMI）增加了包括医疗决策在内的临终关怀的复杂性。对于复杂的病人，加入以团队为基础的临终关怀提供协调的服务和支持。本回顾性研究评估心理健康照护或缓和疗护的结合是否会增加生命最后6个月的安宁疗护登记人数。方法选取诊断为心力衰竭（HF）和重度精神分裂症的退伍军人。重度精神分裂症被定义为精神分裂症或双相情感障碍。我们将重度精神障碍人群分为4组：有精神健康和姑息治疗的人群（n = 2973）、只有精神健康的人群（n = 4333）、只有姑息治疗的人群（n = 892）和没有姑息治疗的人群（n = 1171）。临终关怀在死亡前6个月的使用结果用VA和Medicare记录来测量。逻辑回归比较了心理健康组和姑息治疗组与参照组，并纳入了人口统计学和合并症的调整。结果该队列包括2011年至2020年间死亡的9369名HF和SMI退伍军人。相对于参照组（23.9%安宁疗护），有心理健康投入者接受安宁疗护的机率较低(调整优势比(aOR) = 0.74；95%置信区间（CI） 0.62,0.87)。接受姑息治疗增加了接受精神卫生服务的患者（aOR = 6.67, 95% CI 5.61, 7.92）和只接受姑息治疗的患者（aOR = 5.96, 95% CI 4.86, 7.32）接受临终关怀的调整几率。结论本研究显示重度精神障碍患者在安宁疗护登记方面存在差距。姑息治疗改善了这一差距。加强精神卫生和姑息治疗提供者之间的合作以及交叉培训可能会改善重度精神分裂症患者的体验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

General hospital psychiatry 医学-精神病学

CiteScore

9.60

自引率

2.90%

发文量

125

审稿时长

20 days

期刊介绍： General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.