Implementing Goals of Care Conversations with Veterans in VA Long-Term Care (LTC) Settings
Ann Arbor, MI
View program fact sheet
In January 2017, VA’s National Center for Ethics in Health Care released Handbook 1004.3, “Life Sustaining Treatment Decisions: Eliciting, Documenting, and Honoring Patients’ Values, Goals and Preferences.” Through this handbook, practitioners throughout all VA care delivery settings will be required to:
- Hold Goals of Care (GoC) conversations with seriously ill Veterans and their families,
- Document these findings in CPRS in the life-sustaining treatment template, and
- Develop care plans consistent with the goals expressed by the Veterans and their families.
The overall goal of Long-Term Care QUERI is to support the Veteran-centered implementation of Goals of Care Conversations specifically in Community Living Centers (CLCs) and in Home Based Primary Care (HBPC). Veterans in these settings are often vulnerable and frail, and may face critical decisions about their care. Long-Term Care QUERI investigators are accomplishing the overall impact goal through the following aims:
- Assess variation in practice measures related to implementation of Goals of Care (GoC) conversations in CLCs and HBPC programs over time nationally.
- Design, implement, and test tools to improve performance.
- Use measures derived from two widely-used implementation research frameworks (the Consolidated Framework for Implementation Research and the Theoretical Domains Framework) in order to assess barriers and facilitators to implementing GoC conversations.
- Use interventions coupled with action planning through learning collaboratives, and conduct rapid tests of different designs within these strategies to overcome barriers to implementing GoC conversations in CLCs and HBPC.
Expected Findings and Impact(s):
This QUERI national program is expected to have an impact on Veterans’ health and the VA healthcare system. GoC conversations with Veterans and their families ensure that the treatment they are receiving is concordant with Veterans’ preferences. For example, a Veteran may express their preference for receiving care in a community living center rather than being hospitalized for acute care problems. As Veterans receive care in accordance with their preferences, we anticipate improved patient care experiences and satisfaction.
Principal Investigators: Anne Sales, PhD, RN (Corresponding PI), Mary Ersek, PhD, and Orna Intrator, PhD.
Principal Operational Partners: VA Geriatrics and Extended Care, VACO GEC Operations, National Center for Ethics in Health Care, and the Office of Nursing Services.