姑息治疗可以改善患有生命限制疾病的人的生活质量，这种情况在老年人中很常见。尽管退伍军人健康管理局 (VA) 扩大了门诊姑息治疗范围，但大多数研究仍集中在住院姑息治疗上。本研究旨在比较不同护理环境（住院患者与门诊患者）和剂量（姑息治疗次数）的退伍军人特征和姑息治疗使用者的临终关怀使用情况。该全国队列包括 2014 年至 2017 年期间接受过 VA 姑息治疗的退伍军人。使用退伍军人管理局和医疗保险行政数据（2010-2017）来描述退伍军人人口统计、社会经济地位、生命限制条件、虚弱和姑息治疗的利用。使用诊所停止代码 (353, 351) 和当前程序术语代码 (99241-99245) 来识别专业姑息治疗遭遇。在超过 4 年接受过专业姑息治疗的 120,249 名独特退伍军人中，67.8% 仅在住院环境中接受过姑息治疗（n = 81,523) 和 32.2% 在门诊环境中至少接受过一次姑息治疗 (n = 38,726)，无论有或没有住院姑息治疗。与住院姑息治疗使用者相比，门诊患者和住院患者患癌症的可能性更高，体质虚弱的可能性更小，但包括农村地区和住房不稳定在内的社会人口因素是相似的。住院患者（中位= 37天；IQR= 11, 112）和门诊患者（中位= 44天；IQR= 14, 118）姑息治疗使用者的临终关怀使用时间相似，而仅接受过一次姑息治疗的患者的临终关怀使用时间较短（中位） = 18 天；IQR = 5, 64)。这项国家评估为退伍军人的退伍军人专业姑息治疗的护理环境和剂量提供了新颖的见解。在使用姑息治疗的退伍军人中，三分之一的人至少在门诊护理环境中接受过一些姑息治疗。住院和门诊使用退伍军人之间的差异促使需要进一步研究，以了解护理环境和姑息治疗次数如何影响退伍军人和老年人的结果。© 2024 美国老年医学会。

Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpatient palliative care. This study aimed to compare veteran characteristics and hospice use for palliative care users across care settings (inpatient vs. outpatient) and dose (number of palliative care encounters).This national cohort included veterans with any VA palliative care encounters from 2014 through 2017. We used VA and Medicare administrative data (2010-2017) to describe veteran demographics, socioeconomic status, life-limiting conditions, frailty, and palliative care utilization. Specialty palliative care encounters were identified using clinic stop codes (353, 351) and current procedural terminology codes (99241-99245).Of 120,249 unique veterans with specialty palliative care over 4 years, 67.8% had palliative care only in the inpatient setting (n = 81,523) and 32.2% had at least one palliative care encounter in the outpatient setting (n = 38,726), with or without an inpatient palliative care encounter. Outpatient versus inpatient palliative care users were more likely to have cancer and less likely to have high frailty, but sociodemographic factors including rurality and housing instability were similar. Duration of hospice use was similar between inpatient (median = 37 days; IQR = 11, 112) and outpatient (median = 44 days; IQR = 14, 118) palliative care users, and shorter among those with only one palliative care encounter (median = 18 days; IQR = 5, 64).This national evaluation provides novel insights into the care setting and dose of VA specialty palliative care for veterans. Among veterans with palliative care use, one-third received at least some palliative care in the outpatient care setting. Differences between veterans with inpatient and outpatient use motivate the need for further research to understand how care settings and number of palliative care encounters impact outcomes for veterans and older adults.© 2024 The American Geriatrics Society.