Implementing goals of care conversations with veterans in VA long-term care setting: a mixed methods protocol.
The program "Implementing Goals of Care Conversations with Veterans in VA LTC Settings" is proposed in partnership with the US Veterans Health Administration (VA) National Center for Ethics in Health Care and the Geriatrics and Extended Care Program Offices, together with the VA Office of Nursing Services. The three projects in this program are designed to support a new system-wide mandate requiring providers to conduct and systematically record conversations with veterans about their preferences for care, particularly life-sustaining treatments. These treatments include cardiac resuscitation, mechanical ventilation, and other forms of life support. However, veteran preferences for care go beyond whether or not they receive life-sustaining treatments to include issues such as whether or not they want to be hospitalized if they are acutely ill, and what kinds of comfort care they would like to receive.



Three projects, all focused on improving the provision of veteran-centered care, are proposed. The projects will be conducted in Community Living Centers (VA-owned nursing homes) and VA Home-Based Primary Care programs in five regional networks in the Veterans Health Administration. In all the projects, we will use data from context and barrier and facilitator assessments to design feedback reports for staff to help them understand how well they are meeting the requirement to have conversations with veterans about their preferences and to document them appropriately. We will also use learning collaboratives-meetings in which staff teams come together and problem-solve issues they encounter in how to get veterans' preferences expressed and documented, and acted on-to support action planning to improve performance.



We will use data over time to track implementation success, measured as the proportions of veterans in Community Living Centers (CLCs) and Home-Based Primary Care (HBPC) who have a documented goals of care conversation soon after admission. We will work with our operational partners to spread approaches that work throughout the Veterans Health Administration.
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. salesann@umich.edu.|University of Michigan Medical School, 300 N. Ingalls Street, Room 1161-I, Ann Arbor, MI, 48109-5423, USA. salesann@umich.edu.
Anne E
AE
Sales
Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.|School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
Mary
M
Ersek
Canandaigua VAMC, Canandaigua, NY, USA.|University of Rochester Medical Center, Rochester, NY, USA.
Orna K
OK
Intrator
Eastern Colorado Health Care System, Denver, CO, USA.|School of Medicine, University of Colorado Anschutz Campus, Denver, CO, USA.
Cari
C
Levy
Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.
Joan G
JG
Carpenter
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.|University of Michigan Medical School, 300 N. Ingalls Street, Room 1161-I, Ann Arbor, MI, 48109-5423, USA.
Robert
R
Hogikyan
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.|University of Michigan Medical School, 300 N. Ingalls Street, Room 1161-I, Ann Arbor, MI, 48109-5423, USA.
Helen C
HC
Kales
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Zach
Z
Landis-Lewis
Canandaigua VAMC, Canandaigua, NY, USA.|University of Rochester Medical Center, Rochester, NY, USA.
Tobie
T
Olsan
Brown University School of Public Health, Providence, RI, USA.
Susan C
SC
Miller
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.|University of Michigan Medical School, 300 N. Ingalls Street, Room 1161-I, Ann Arbor, MI, 48109-5423, USA.
Marcos
M
Montagnini
VA Palo Alto Health Care System, Palo Alto, CA, USA.|Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA.
Vyjeyanthi S
VS
Periyakoil
Puget Sound Health Care System, Seattle, WA, USA.
Sheri
S
Reder
D003142:Communication; D006040:Goals; D006801:Humans; D008134:Long-Term Care; D010347:Patient Care Planning; D010358:Patient Participation / Q000379:methods*; D015397:Program Evaluation / Q000379:methods*; D012107:Research Design; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D058014:Veterans Health
Feedback interventions; Goals of care conversations; Implementation science; Learning collaboratives; Long-term care
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