Implementing goals of care conversations with veterans in VA long term care settings

Healthcare / audit partner. Data are electronically stored in VA Corporate Data Warehouse; operational partner is VA National Center for Ethics in Health Care.

Research partners. CCMR, VA Ann Arbor Healthcare System; Philadelphia VA Medical Center; Denver VA Medical Center.

Context. A new VA Handbook, the Life Sustaining Treatment Decision Initiative (LSTDI), has been disseminated to VHA facilities requiring documentation of goals of care conversations using a detailed standardized template in the VA EMR for recording these conversations. This initiative applies to seriously ill Veterans in all VHA settings. Our project focuses on implementing this Handbook and the related template in long term care settings (VA owned nursing homes and home based primary care).

Aim of audit. Data are electronically extracted from existing national databases for the purpose of understanding proportion of long term care patients who have had a goals of care conversation documented in the standardized template.

Scope and scale of audit. All Veterans in Community Living Centers (VA owned nursing homes) and Home Based Primary Care throughout the Veterans Health Administration in the United States.

Aim of research. To support implementation of the LSTDI in long term care settings throughout VHA in VISN 4 (Pennsylvania), VISN 10 (Michigan and Indiana), and VISN 19 (Colorado, Utah, Wyoming, Montana and Oklahoma).

A&F interventions being tested. Electronically generated feedback reports providing feedback on performance in documenting goals of care conversations, coupled with learning collaboratives. Different formats and delivery of feedback reports will be tested.

Evaluation design. Quasi-experimental mixed methods design using interrupted time series.

Oversight. Steering Committee comprised of three VA operational partners: Geriatrics and Extended Care Service; National Center for Ethics in Health Care; and the Office of Nursing Services.

Ethical approval. Exempted from review as quality improvement by VA Ann Arbor Healthcare System Research and Development Committee.

Audit funding. N/A.

Research funding. VA QUERI Program (QUE 15-288).

Trial registration. N/A.