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In January 2017, the 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 care delivery settings in VA will be required to hold Goals of Care (GoC) conversations with Veterans and their families, to document these findings in VA’s computerized patient record system (CPRS) in the life-sustaining treatment template, and to develop care plans consistent with the goals expressed by Veterans and their families. VA facilities are expected to have this initiative fully implemented by July 2018.
The Implementing Goals of Care Conversations with Veterans in VA Long-Term Care (LTC) Settings QUERI program focuses on improving Veteran-centered care in VA Community Living Centers (CLCs) and in Home-Based Primary Care (HBPC). Veterans in these settings are often vulnerable, frail, and may face critical decisions about their care. Thus, one of LTC-QUERI’s projects is aimed at supporting the implementation of Goals of Care Conversations, specifically in CLCs and in HBPC. Investigators plan to accomplish this through the following aims:
- Assess variation in practice measures related to implementation of Goals of Care conversations in CLCs and HBPC programs over time nationally.
- Design, implement, and test tools to improve performance, including:
- Tools for feedback reports to provide information on progress in those key measures, and
- Tools for learning collaboratives to support action-planning to address performance gaps.
- Use measures derived from two widely-used implementation research frameworks (the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework) in order to assess barriers and facilitators to implementing GoC conversations.
- Use audit with feedback 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.
It is anticipated that this program will have an impact on Veterans’ health and the VA healthcare system. GoC conversations with Veterans and their families ensure that the treatment they receive is concordant with Veterans’ preferences. For example, a Veteran may express their preference for receiving care in the CLC 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.
LTC-QUERI’s operational partners in this program include VA’s Central Office Geriatrics and Extended Care Policy and Planning and VACO GEC Operations, the National Center for Ethics in Health Care, the Office of Nursing Services, and their VISN partners.