Implementing Goals of Care Conversations with Veterans in VA LTC Settings

在 VA LTC 环境中实现与退伍军人的护理对话目标

• 批准号: 9074697
• 负责人: MARY ERSEK
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9074697
• 关键词: Acute; Address; Address; Admission activity; Admission activity; Advance Directives; Advance Directives; Alzheimer' s Disease; Alzheimer' s Disease; Assessment tool; Attention; Attention; CLC Gene; Cardiac; Cardiopulmonary Resuscitation; Caregivers; Caring; Caring; Complex; Complex; Computerized Patient Records; Computerized Patient Records; Coupled; Coupled; Data; Data; Data Set; Data Set; Dementia; Dementia; Documentation; Documentation; Emergency Situation; Emergency Situation; Ensure; Ensure; Ethics; Ethics; Event; Event; Face; Face; Family; Family; Family Caregiver; Feedback; Feedback; Geriatrics; Geriatrics; Goals; Goals; Health; Health; Health Services; Healthcare; Healthcare; Home environment; Home environment; Intervention; Intervention; Learning; Learning; Life; Life; Long-Term Care; Long-Term Care; Measures; Measures; Mechanical ventilation; Mechanical ventilation; Modeling; Monitor; Monitor; Nursing Homes; Nursing Homes; Nursing Services; Nursing Services; Office Nursing; Office Nursing; Palliative Care; Palliative Care; Patients; Patients; Performance; Performance; Physical activity; Physical activity; Population; Population; Primary Health Care; Primary Health Care; Problem Solving; Problem Solving; Process; Process; Provider; Reporting; Reporting; Resuscitation; Service delivery model; Services; Services; Signal Transduction; Signal Transduction; Standardization; System; System; Testing; Testing; Time; Time; Update; Update; Variant; Variant; Veterans; Veterans; Work; Work; aging population; aging population; base; base; behavior change; behavior change; care delivery; care delivery; care preference; care preference; care providers; care systems; clinical care; clinical care; community living; community living; data centers; demographics; demographics; design; design; end of life; end of life; expectation; expectation; experience; experience; family support; follow-up; follow-up; handbook; handbook; health administration; health administration; health care delivery; health care delivery; health care service; implementation research; implementation research; implementation strategy; improved; improved; instrument; meetings; meetings; member; member; multidisciplinary; multidisciplinary; novel strategies; novel strategies; patient home care; patient home care; preference; preference; programs; programs; service intervention; service intervention; shared decision making; shared decision making; standard of care; standard of care; tool; tool

 DESCRIPTION (provided by applicant): The Program "Implementing Goals of Care Conversations with Veterans in VA LTC Settings" is proposed in partnership with the VA National Center for Ethics in Health Care and the Geriatrics and Extended Care Program Offices, together with the VA Office of Nursing Services. Four 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 Home Based Primary Care Programs in five regional networks in the Veterans Health Administration. They are all designed to support a new program to ask Veterans in these settings about their preferences for care, particularly health care services and interventions that are typically used i the event of a life threatening emergency, or life-sustaining measures. These measures include, but are not limited to, 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, and include whether or not they want to be hospitalized if they are acutely ill, what kinds of comfort care they would like to receive, and what kinds of physical activity they would like to experience, even near the end of life. The four projects are all planne as quality improvement projects. Two focus on implementing new approaches to asking about preferences for care and making sure that these preferences are documented where everyone providing care to a Veteran can find them. One focuses on getting this new approach implemented in Community Living Centers, and the other focuses on similar work among teams of care providers who go into Veterans' homes to provide care there. Both follow up with staff in these settings to make sure that Veterans' expressed preferences are incorporated into the services they receive. The other two projects focus on how to improve care for Veterans with dementia, such as Alzheimer's Disease, and on how to increase the amount of physical activity Veterans are offered when they are near the end of life and living either in a Community Living Center or at home receiving services from the VA. In all the projects, we will use information to design feedback reports for staff to help them understand how well they are meeting expectations in terms of asking Veterans about their preferences, and documenting them as expected. We will also use what are called "learning collaboratives"-meetings in which staff teams come together and problem-solve issues they encounter in how to get Veterans' preferences expressed and documented, as well as how to make sure that those preferences are acted on. We will use data over time to see whether there are improvements following the work we do. We will work with our operational partners to spread approaches that work throughout the Veterans Health Administration.

 描述（由申请人提供）： “在退伍军人长期护理中心实施与退伍军人护理对话的目标”计划是与退伍军人管理局国家医疗保健道德中心、老年病学和长期护理计划办公室以及退伍军人管理局护理服务办公室合作提出的四个项目，这些项目均旨在改善以退伍军人为中心的护理服务，将在退伍军人健康管理局五个区域网络的社区生活中心（退伍军人管理局拥有的疗养院）和家庭初级护理计划中进行。所有这些都是为了支持一项新计划，询问这些环境中的退伍军人对护理的偏好，特别是在发生危及生命的紧急情况时通常使用的医疗保健服务和干预措施，或维持生命的措施，这些措施包括但不限于。不限于心脏复苏、机械通气和其他形式的生命支持。然而，退伍军人对护理的偏好超出了他们是否接受生命维持治疗的范围，还包括他们是否愿意在病情严重时住院。他们希望获得什么样的舒适护理，以及他们想要体验什么样的身体活动，甚至在生命即将结束时，这四个项目都计划作为提高质量的项目，其中两个重点是实施新方法来询问护理偏好并确保这些偏好被记录下来。每个为退伍军人提供护理的人都可以找到他们，一个重点是在社区生活中心实施这一新方法，另一个重点是在进入退伍军人之家提供护理的护理人员团队中进行类似的工作。与这些环境中的工作人员合作，以确保退伍军人表达的偏好得到尊重另外两个项目的重点是如何改善对患有痴呆症（如阿尔茨海默病）的退伍军人的护理，以及如何增加退伍军人在生命即将结束时的身体活动量。无论是在社区生活中心还是在家里接受退伍军人管理局的服务，在所有项目中，我们将使用信息为工作人员设计反馈报告，以帮助他们了解他们在询问退伍军人的偏好方面是否满足了期望。我们还将使用所谓的内容来记录它们。 “学习协作”——工作人员团队聚集在一起的会议，解决他们在如何表达和记录退伍军人的偏好以及如何确保这些偏好得到落实方面遇到的问题。随着时间的推移，我们将使用数据。看看我们所做的工作是否有所改进，我们将与我们的业务合作伙伴合作，在整个退伍军人健康管理局推广有效的方法。

项目成果

Honoring Veterans' Preferences: The Association Between Comfort Care Goals and Care Received at the End of Life.

尊重退伍军人的偏好：舒适护理目标与临终护理之间的关联。

• DOI: 10.1016/j.jpainsymman.2020.08.039
• 发表时间: 2021
• 期刊: Journal of pain and symptom management
• 影响因子: 4.7
• 作者: Miller,SusanC;Scott,WinifredJ;Ersek,Mary;Levy,Cari;Hogikyan,Robert;Periyakoil,VyjeynathiS;Carpenter,JoanG;Cohen,Jennifer;Foglia,MaryBeth
• 通讯作者: Foglia,MaryBeth

Family members' experience improves with care preference documentation in home based primary care.

• DOI: 10.1111/jgs.17410
• 发表时间: 2021-12
• 期刊: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
• 影响因子: 6.3
• 作者: Levy, Cari;Esmaeili, Aryan;Smith, Dawn;Hogikyan, Robert;Periyakoil, Vyjeyanthi;Carpenter, Joan G.;Sales, Anne;Ersek, Mary
• 通讯作者: Ersek, Mary