QUERI – Quality Enhancement Research Initiative

QUERI E-news
May 2020

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Now More than Ever, Advance Directives are Important

One of VA’s Diffusion of Excellence Initiatives, the objective of QUERI’s ACP-GV is to evaluate and  determine best practices to facilitate a nationwide spread of ACP-GV, which includes the cost saving- and process-oriented approach of hosting discussions regarding the topic of advanced care planning and advanced directives among groups of Veterans.

Takeaway: VA is here to support Veterans with Advance Care Planning discussions. Now more than ever, it is important for Veterans to communicate their healthcare wishes with their loved ones and their VA providers, particularly Veterans who are more vulnerable to COVID-19.

Advance Care Planning (ACP) is the process by which individuals make clear their choices regarding healthcare if they are in a situation in which they can no longer communicate their wishes or are unable to make their own decisions. VA offers Advance Care Planning information with links to the VA Advance Directive form, as well as podcasts on ACP; however, based on community advance directive completion rates of 26%, it is estimated that nearly 7 million of the 9 million Veterans currently enrolled in the VA healthcare system do not have an advance directive and are at risk of being hospitalized without their medical preferences being known. So how do we help Veterans realize the importance of ACP?

“That’s it!” exclaimed Dr. Monica Matthieu. “Say that again.”

“Now more than ever, it is important that your healthcare wishes are known and documented,” repeated Laura Taylor, LSCSW, National Director, Social Work, Office of Care Management and Social Work.

Dr. Matthieu and Ms. Taylor found words to express what the team was feeling while gathered for a weekly leadership meeting of the implementation and evaluation teams between QUERI’s Evaluation of the National Implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits (ACP-GV) and operations partners from VA’s Office of Rural Health (ORH) and VHA Social Work.

“Yes, we want to ensure Veterans receive the care they prefer in the event of a medical crisis or surrounding end-of-life care,” stated Kimberly Garner, MD, JD, national program lead for ACP-GV and VISN 16 Rehabilitation and Extended Care Lead. “It is essential that advance care planning is conducted with our Veterans so that their preferences are known and documented in an Advance Directive (AD).”

In ACP-GV, Veterans, their families, and trained clinical staff with expertise in advanced care planning meet in a group setting to have discussions about ACP. These groups discuss the benefits to Veterans and their trusted others of having an Advance Directive  in place. These discussions can potentially decrease the risk of Veterans receiving care that is different than what they would prefer or receiving unwanted interventions that could lead to increased suffering and higher health care costs. To meet needs of Veterans in these rapidly changing times, sites are using remote technology to reach Veterans with ACP discussions.

At one ACP-GV site, LaTonya Carter, LCSW, a social worker at the Atlanta VA Healthcare System, noted that she used VA Video Connect to host discussions regarding the topic of ACP among groups of Veterans. One Veteran shared this perspective, "This is a great way to introduce the subject. A lot of times we don't need to be in person." VA Video Connect allows Veterans and their caregivers to quickly and easily meet with VA healthcare providers through live video on any computer, tablet, or mobile device with an internet connection.

According to Dr. Garner, VA is here to support Veterans with ACP discussions. Now more than ever, it is time for Veterans to communicate their healthcare wishes with their loved ones and their VA providers. Currently, there are 51 ACP-GV sites, defined as VA Medical Centers that are adopting or implementing ACP-GV.

For more information on becoming an ACP-GV site, please visit the ACP-GV National Program SharePoint site on the VA intranet for new site orientation training schedule. You may also contact Monica Matthieu at Monica.Matthieu@va.gov .

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