Cuidados paliativos y medicina

Abstracto

Autopsy Rates in the Department of Veterans Affairs Comparisons by Treating Specialty and Venue

Gary Hsin, Periyakoil VJ and James Hallenbeck

Background: Institutional autopsy rates have fallen in recent years. Significant variability in autopsy rates by venue of care has been described.

Objectives: To compare institutional autopsy rates by treatment specialty and venue in the Department of Veterans Affairs and to the community. To explore the role of palliative care in autopsy inquiries.

Research Design: Compare national autopsy rates by acute care and nursing home treating specialties for two fiscal years.

Subjects: Decedents as recorded anonymously in a national VA database, classified by terminal venue of care, treating specialty, and autopsy status.

Measures: Chi-squared, Odds ratios for data using nominal scales, linear regression for interval scale data.

Results: 40,481 deaths in fiscal years 2006-2007 were examined. As compared to those dying in general medicine (autopsy rate [A.R]: 7.6%), decedents elsewhere were significantly more likely to undergo autopsies on surgical intensive care (A.R: 14.7%), surgical ward (A.R: 15.7%), or medical intensive care (A.R: 10.6%) treating specialties (Odds ratio [O.R]: 2.10, 2.27, 1.45, respectively, p.0.000) and less likely to undergo autopsy in nursing home (A.R: 5.7%) or inpatient hospice (A.R: 3.7%) treating specialties (O.R: 0.74, 0.47 respectively). VA acute hospital autopsy rates have declined 29% over the past 10 years.

Conclusions: VA autopsy rates show significant variation across venues and specialties, but are still generally higher than in the private sector, although still low against historic norms. Significant changes in education and processes regarding autopsy inquiry must take place.