scholarly journals Evaluation of the national implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits: Protocol for a quality improvement evaluation

2020 ◽  
Author(s):  
Monica M. Matthieu ◽  
Songthip T. Ounpraseuth ◽  
Jacob Painter ◽  
Angie Waliski ◽  
James “Silas” Williams ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Advance Care Planning ◽  
Implementation Strategies ◽  
Care Planning ◽  
National Program ◽  
Group Setting ◽  
Group Visits ◽  
National Implementation ◽  
Advance Care ◽  
The Impact

Abstract Background Traditionally system leaders, service line managers, researchers, and program evaluators, hire specifically dedicated implementation staff to ensure that a healthcare quality improvement effort can “go to scale”. However, little is known about the impact of hiring dedicated staff and whether funded positions, amid a host of other delivered implementation strategies, is the main difference among sites with and without funding used to execute the program, on implementation effectiveness and cost outcomes. Methods/Design In this mixed methods program evaluation, we will determine the impact of funding staff positions to implement, sustain, and spread a program, Advance Care Planning (ACP) via Group Visits (ACP-GV), nationally across the entire United States Department of Veterans Affairs (VA) healthcare system. In ACP-GV, Veterans, their families, and trained clinical staff with expertise in ACP meet in a group setting to engage in discussions about ACP and the benefits to Veterans and their trusted others of having an Advance Directive (AD) in place. To determine the impact of the ACP-GV National Program, we will use a propensity score matched control design to compare ACP-GV and non-ACP-GV sites on the proportion of ACP discussions in VHA facilities. To account for variation in funding status, we will document and compare funded and unfunded sites on the effectiveness of implementation strategies (individual and combinations) used by sites in the National Program on ACP discussion and AD completion rates across the VHA. In order to determine the fiscal impact of the National Program and to help inform future dissemination across VHA, we will use a budget impact analysis. Finally, we will purposively select, recruit, and interview key stakeholders, who are clinicians and clinical managers in the VHA who offer ACP discussions to Veterans, to identify the characteristics of high-performing (e.g., high rates or sustainers) and innovative sites (e.g., unique local program design or implementation of ACP) to inform sustainability and further spread. Discussion As an observational evaluation, this protocol will contribute to our understanding of implementation science and practice by examining the natural variation in implementation and spread of ACP-GV with or without funded staff positions.

scholarly journals Evaluation of the national implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits: Protocol for a quality improvement evaluation

2020 ◽  
Author(s):  
Monica M. Matthieu ◽  
Songthip T. Ounpraseuth ◽  
Jacob Painter ◽  
Angie Waliski ◽  
James “Silas” Williams ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Advance Care Planning ◽  
Implementation Strategies ◽  
Care Planning ◽  
National Program ◽  
Group Setting ◽  
Group Visits ◽  
National Implementation ◽  
Advance Care ◽  
The Impact

Abstract Background Traditionally system leaders, service line managers, researchers, and program evaluators, hire specifically dedicated implementation staff to ensure that a healthcare quality improvement effort can “go to scale”. However, little is known about the impact of hiring dedicated staff and whether funded positions, amid a host of other delivered implementation strategies, is the main difference among sites with and without funding used to execute the program, on implementation effectiveness and cost outcomes. Methods/Design In this mixed methods program evaluation, we will determine the impact of funding staff positions to implement, sustain, and spread a program, Advance Care Planning (ACP) via Group Visits (ACP-GV), nationally across the entire United States Department of Veterans Affairs (VA) healthcare system. In ACP-GV, Veterans, their families, and trained clinical staff with expertise in ACP meet in a group setting to engage in discussions about ACP and the benefits to Veterans and their trusted others of having an Advance Directive (AD) in place. To determine the impact of the ACP-GV National Program, we will use a propensity score matched control design to compare ACP-GV and non-ACP-GV sites on the proportion of ACP discussions in VHA facilities. To account for variation in funding status, we will document and compare funded and unfunded sites on the effectiveness of implementation strategies (individual and combinations) used by sites in the National Program on ACP discussion and AD completion rates across the VHA. In order to determine the fiscal impact of the National Program and to help inform future dissemination across VHA, we will use a budget impact analysis. Finally, we will purposively select, recruit, and interview key stakeholders, who are clinicians and clinical managers in the VHA who offer ACP discussions to Veterans, to identify the characteristics of high-performing (e.g., high rates or sustainers) and innovative sites (e.g., unique local program design or implementation of ACP) to inform sustainability and further spread. Discussion As an observational evaluation, this protocol will contribute to our understanding of implementation science and practice by examining the natural variation in implementation and spread of ACP-GV with or without funded staff positions.

scholarly journals NATIONAL IMPLEMENTATION OF A VHA DIFFUSION OF EXCELLENCE GOLD STATUS PRACTICE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S476-S476
Author(s):  
Kimberly K Garner ◽  
Jamie Jensen ◽  
Lisa Nabholz ◽  
Melissa Harding ◽  
Laura Taylor
Keyword(s):  
Advance Care Planning ◽  
Healthcare Setting ◽  
Dissemination And Implementation ◽  
Care Planning ◽  
Fee For Service ◽  
Department Of Veterans Affairs ◽  
Group Visits ◽  
Medical Centers ◽  
National Implementation ◽  
Advance Care

Abstract Advance care planning (ACP) is a health behavior that requires in-depth discussions support by trained professionals and motivational strategies to promote goal-setting and actions. Group visits in the healthcare setting can effectively increase an individual’s motivation and self-efficacy for ACP. The Department of Veterans Affairs (VA) has developed the Diffusion of Excellence Initiative to identify and spread innovative practices such as Advance Care Planning via Group Visits (ACP-GV), which uses an interactive group session to engage Veterans in thinking about and planning for their future medical decisions. In these sessions, social workers, nurses, psychologists, and chaplains, facilitate group discussions to increase the chance that a Veteran’s care preferences are known and reflect with their wishes. This also can relieve trusted others of having to make these tough decisions without much guidance. In addition, ACP-GV increases the effectiveness of advance care planning through allowing Veterans to discuss and process this complex topic with their peers. To date, 36 VA Medical Centers (VAMCs) are currently adopting, implementing or sustaining this practice and more than 15,250 Veterans have attended ACP-GV sessions. In addition, another 40 VAMCs are exploring participating this practice. Of those participants, approximately 18-20% develop a new advance directive and 86% set a smart goal to take steps toward advance care planning. Continued dissemination and implementation of this innovative practice is ongoing. After the session, attendees will have practical guidance for implementation of ACP-GV discussions in integrated (VA) or fee-for-service (Medicare) settings.

scholarly journals Racial Differences in the Impact of Subjective Life Expectancy on Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 903-903
Author(s):  
Yifan Lou ◽  
Deborah Carr
Keyword(s):  
Life Expectancy ◽  
Racial Differences ◽  
Advance Care Planning ◽  
Living Will ◽  
Care Planning ◽  
Power Of Attorney ◽  
Risk Of Death ◽  
Advance Care ◽  
Survival Expectations ◽  
The Impact

Abstract The need for advance care planning (ACP) is heightened during the COVID-19 pandemic, especially for older Blacks and Latinx persons who are at a disproportionate risk of death from both infectious and chronic disease. A potentially important yet underexplored explanation for well-documented racial disparities in ACP is subjective life expectancy (SLE), which may impel or impede ACP. Using Health and Retirement Study data (n=7484), we examined the extent to which perceived chances of living another 10 years (100, 51-99, 50, 1-49, or 0 percent) predict three aspects of ACP (living will (LW), durable power of attorney for health care designations (DPAHC), and discussions). We use logistic regression models to predict the odds of each ACP behavior, adjusted for sociodemographic, health, and depressive symptoms. We found modest evidence that SLE predicts ACP behaviors. Persons who are 100% certain they will be alive in ten years are less likely (OR = .68 and .71, respectively) whereas those with pessimistic survival prospects are more likely (OR = 1.23 and 1.15, respectively) to have a LW and a DPAHC, relative to those with modest perceived survival. However, upon closer inspection, these patterns hold only for those whose LW specify aggressive measures versus no LW. We found no race differences for formal aspects of planning (LW, DPAHC) although we did detect differences for informal discussions. Blacks with pessimistic survival expectations are more likely to have discussions, whereas Latinos are less likely relative to whites. We discuss implications for policies and practices to increase ACP rates.

Discussion and documentation of future care: a before-and-after study examining the impact of an alternative approach to recording treatment decisions on advance care planning in an acute hospital

2017 ◽  
Vol 10 (2) ◽  
pp. e12-e12 ◽  
Author(s):  
Alexandra C Malyon ◽  
Julia R Forman ◽  
Jonathan P Fuld ◽  
Zoë Fritz
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Treatment Decisions ◽  
Care Planning ◽  
New Approach ◽  
Significance Level ◽  
Oncology Ward ◽  
Future Care ◽  
Advance Care ◽  
The Impact

ObjectiveTo determine whether discussion and documentation of decisions about future care was improved following the introduction of a new approach to recording treatment decisions: the Universal Form of Treatment Options (UFTO).MethodsRetrospective review of the medical records of patients who died within 90 days of admission to oncology or respiratory medicine wards over two 3-month periods, preimplementation and postimplementation of the UFTO. A sample size of 70 per group was required to provide 80% power to observe a change from 15% to 35% in discussion or documentation of advance care planning (ACP), using a two-sided test at the 5% significance level.ResultsOn the oncology ward, introduction of the UFTO was associated with a statistically significant increase in cardiopulmonary resuscitation decisions documented for patients (pre-UFTO 52% to post-UFTO 77%, p=0.01) and an increase in discussions regarding ACP (pre-UFTO 27%, post-UFTO 49%, p=0.03). There were no demonstrable changes in practice on the respiratory ward. Only one patient came into hospital with a formal ACP document.ConclusionsDespite patients’ proximity to the end-of-life, there was limited documentation of ACP and almost no evidence of formalised ACP. The introduction of the UFTO was associated with a change in practice on the oncology ward but this was not observed for respiratory patients. A new approach to recording treatment decisions may contribute to improving discussion and documentation about future care but further work is needed to ensure that all patients’ preferences for treatment and care at the end-of-life are known.

The Impact of Personal and Professional Loss on Advance Care Planning and Effective Care Delivery for Healthcare Social Workers

2018 ◽  
Vol 99 (4) ◽  
pp. 358-368
Author(s):  
Cara L. Wallace ◽  
Yit Mui Khoo ◽  
Leslie Hinyard ◽  
Jennifer E. Ohs ◽  
Dulce M. Cruz-Oliver
Keyword(s):  
Social Workers ◽  
Advance Care Planning ◽  
Care Delivery ◽  
Death And Dying ◽  
Care Planning ◽  
Professional Experiences ◽  
Effective Care ◽  
Advance Care ◽  
Past Experiences ◽  
The Impact

Personal experiences can influence the practice of social work. However, the connection between past experiences with death and social workers’ practice has been underexplored. As such, this study surveyed social workers ( N = 74) about their personal and professional experiences of loss, personal advance care planning, and professional practices. Results demonstrated that social workers that experienced prior loss were more likely to complete an advance directive and communicate their end-of-life wishes. Additionally, those who had experienced personal and professional loss showed greater effectiveness on measures of patient- and family-centered communication and care delivery. Findings suggest positive outcomes for encouraging social workers to connect their personal and professional experiences surrounding death and dying to effectively serve in their professional capacity.

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