scholarly journals VA’s Life-Sustaining Treatment Decisions Initiative: First 20 Months of National Implementation

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 752-752
Author(s):  
Mary Ersek ◽  
Winifred Scott ◽  
Joan Carpenter ◽  
Jennifer Kononowech ◽  
Ciarian Phibbs ◽  
...  
Keyword(s):  
Nursing Home ◽  
Observational Study ◽  
Treatment Decisions ◽  
Older Age ◽  
Retrospective Observational Study ◽  
Goals Of Care ◽  
Care Assessment ◽  
National Implementation ◽  
Life Sustaining Treatment ◽  
Nursing Home Stay

Abstract This retrospective observational study describes the first 20 months of implementing the Life-Sustaining Treatment Decisions Initiative. We examined patient and facility characteristics associated with life sustaining treatment (LST) orders template completion, including the association between template completion and the Care Assessment Need (CAN) score, which quantifies Veterans’ risk of hospitalization and mortality. As of February 29, 2020, over 274,200 Veterans received at least one goal of care conversation and LST preferences documented on a template. Eighty-two percent of deceased Veterans with the highest risk of hospitalization or mortality had an LST note and order documented prior to their death. Factors that predicted a greater likelihood of LST template completion included higher CAN score, older age, nursing home stay, and being white non-Hispanic. Findings suggest that clinicians are engaging older, sicker veterans in goals of care conversations. Research is needed to understand potential disparities in LST template completion.

Pilot of the Life-Sustaining Treatment Decisions Initiative Among Veterans With Serious Illness

2020 ◽  
Vol 38 (1) ◽  
pp. 68-76
Author(s):  
Karleen F. Giannitrapani ◽  
Anne M. Walling ◽  
Ariadna Garcia ◽  
MaryBeth Foglia ◽  
Jill S. Lowery ◽  
...  
Keyword(s):  
Treatment Decisions ◽  
Department Of Veterans Affairs ◽  
Do Not Resuscitate ◽  
Policy And Practice ◽  
Goals Of Care ◽  
Chart Abstraction ◽  
Integrated Health Care System ◽  
Life Sustaining Treatment ◽  
Seriously Ill Patients ◽  
Seriously Ill

Background: Prior to national spread, the Department of Veterans Affairs implemented a pilot of the life-sustaining treatment decisions initiative (LSTDI) to promote proactive goals of care conversations (GoCC) with seriously ill patients, including policy and practice standards, an electronic documentation template and order set, and implementation support. Aim: To describe a 2-year pilot of the LSTDI at 4 demonstration sites. Design: Prospective observational study. Setting/Participants: A total of 6664 patients who had at least one GoCC. Results: Descriptive statistics characterized patient demographics, goals of care, LST decisions, and risk of hospitalization or mortality among patients with at least one GoCC. Participants were on average 71.4 years old, 93.2% male, 87.1% white, and 64.7% urban; 27.3% died by the end of the pilot period. Fifteen percent lacked decision-making capacity (DMC). Nonmutually exclusive goals included to be cured (7.6%), to prolong life (34%), to improve/maintain quality of life (61.5%), to be comfortable (53%), to obtain support for family/caregiver (8.4%), to achieve life goals (2.1%), and other (10.5%). Many GoCCs resulted in a do not resuscitate (DNR) order (58.8%). Patients without DMC were more likely to have comfort-oriented goals (77.3% vs 48.8%) and a DNR (84% vs 52.6%). Chart abstraction supported content validity of GoCC documentation. Conclusion: The pilot demonstrated that standardizing practices for eliciting and documenting GoCCs resulted in customized documentation of goals of care and LST decisions of a large number of seriously ill patients and established the feasibility of spreading standardized practices throughout a large integrated health care system.

scholarly journals Changing Culture Around Serious Illness: The VA Life-Sustaining Treatment Decisions Initiative

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 751-752
Author(s):  
Joan Carpenter ◽  
Robert Burke
Keyword(s):  
Treatment Decisions ◽  
Treatment Preferences ◽  
Veterans Health ◽  
Health Administration ◽  
Comfort Care ◽  
Goals Of Care ◽  
Serious Illness ◽  
Wide Range ◽  
Life Sustaining Treatment ◽  
Seriously Ill

Abstract Discussing and documenting goals of care and life-sustaining treatment decisions with seriously ill patients is a widely endorsed practice by healthcare and professional organizations. In 2018, The Veterans Health Administration (VA) initiated a new national policy to standardize such practices, the Life Sustaining Treatment Decisions Initiative (LSTDI), which included a coordinated set of evidence-based strategies and practice standards for conducting, documenting, and supporting high-quality goals of care conversations (GoCCs); staff training to enhance skills in conducting, documenting, and supporting GoCCs; standardized, durable electronic health record tools for documenting patients’ goals and preferences; and monitoring and information technology tools to support implementation and improvement. In this symposium, we will describe the first 20 months of implementing the LSTDI across the VA, the largest integrated healthcare system in the US. The first paper will focus on the factors associated with documentation of a GoCC and treatment preferences. The second paper will present findings describing facilitators and barriers to implementing the LSTDI and identifying factors that promote high rates of LSTDI documentation. The third paper examines patient level outcomes associated with a documented goal of comfort care, specifically the odds of receipt of hospice/palliative care, hospitalization, or ICU admission. This symposium will provide attendees with important information regarding a wide range of individual and system strategies to enhance the care of seriously ill older adults by engaging patients with serious illness in GoCCs and documenting their preferences for treatment in durable, easily accessible notes and orders.

scholarly journals Variables Impacting Nursing Home Goals of Care Discussions and Order Implementation During COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 734-734
Author(s):  
Orah Burack ◽  
Joann Reinhardt ◽  
Wingyun Mak ◽  
Himali Weerahandi ◽  
Benjamin Canter ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nurse Practitioners ◽  
Older Age ◽  
Treatment Preferences ◽  
Severe Illness ◽  
Cognitively Impaired ◽  
Short Stay ◽  
Do Not Resuscitate ◽  
Goals Of Care ◽  
Specialized Care

Abstract Nursing home (NH) residents are especially vulnerable to COVID-19, disproportionately suffering from severe illness and death. As such, resident Goals of Care (GOC) often had to be quickly established to ensure treatment preferences were known and respected. This study examined variables related to the occurrence of GOC discussions and added orders (Do Not Resuscitate, Do Not Intubate, and Do Not Hospitalize), including demographic, physical functioning, cognitive impairment, depression, number of diagnoses, and Optum participation (Optum provided added specialized care by nurse practitioners who routinely address GOC preferences). Subjects were 286 COVID positive residents from a large NYC NH. All data were obtained from the NH’s electronic medical records. Patient median age was 81 n (interquartile range 71-88), 59% were female, 61% were long stay (stay >100 days) and 39% were short stay. Using bivariate correlations we found that older short stay residents were more likely to have GOC conversations. Additionally, older, cognitively impaired, Optum participants were more likely to have orders added. When all independent variables were entered into binary logistic regressions, only older age and being a primary English speaker were significantly related to the occurrence of GOC conversations (□2= 21.76**; N=278; Nagelkerke R2 = .10), while older age and being an Optum participant were related to added orders (□2=32.18**; N=164; Nagelkerke R2 = .24). Results have implications for (1) ensuring the GOC wishes of diverse populations are known and abided by and (2) improving the quality of clinician – resident GOC discussions.

Life-Sustaining Treatment Decisions for Nursing Home Residents: Who Discusses, Who Decides and What Is Decided?

1999 ◽  
Vol 47 (1) ◽  
pp. 82-87 ◽  
Author(s):  
Jennifer R. Levin ◽  
Neil S. Wenger ◽  
Joseph G. Ouslander ◽  
Gail Zellman ◽  
John F. Schnelle ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Home Residents ◽  
Treatment Decisions ◽  
Life Sustaining Treatment

scholarly journals Comparison of severity predictive rules for hospitalised nursing home-acquired pneumonia in Korea: a retrospective observational study

2013 ◽  
Vol 22 (2) ◽  
pp. 149-154 ◽  
Author(s):  
Jong-Chan Lee ◽  
Hee-Jin Hwang ◽  
Yo-Han Park ◽  
Jun-Hyeon Joe ◽  
Jae-Ho Chung ◽  
...  
Keyword(s):  
Nursing Home ◽  
Observational Study ◽  
Retrospective Observational Study

Hemmkörperentwicklung bei Hämophilie-Patienten nach Präparate wechsel

2012 ◽  
Vol 32 (S 01) ◽  
pp. S39-S42 ◽  
Author(s):  
S. Kocher ◽  
G. Asmelash ◽  
V. Makki ◽  
S. Müller ◽  
S. Krekeler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Observational Study ◽  
Retrospective Observational Study ◽  
Frequent Change ◽  
Patient Age ◽  
Treatment Regimens ◽  
Patient Âgé ◽  
The Relationship ◽  
Observation Period

SummaryThe retrospective observational study surveys the relationship between development of inhibitors in the treatment of haemophilia patients and risk factors such as changing FVIII products. A total of 119 patients were included in this study, 198 changes of FVIII products were evaluated. Results: During the observation period of 12 months none of the patients developed an inhibitor, which was temporally associated with a change of FVIII products. A frequent change of FVIII products didn’t lead to an increase in inhibitor risk. The change between plasmatic and recombinant preparations could not be confirmed as a risk factor. Furthermore, no correlation between treatment regimens, severity, patient age and comorbidities of the patients could be found.

Sign in / Sign up

Export Citation Format

Share Document