Implementing Goals of Care Conversations with Veterans in VA LTC Settings

 描述（由申请人提供）： 该计划“实现目标的护理对话与退伍军人在VA LTC设置”提出了与VA国家中心的道德在医疗保健和老年病和延长护理计划办公室，连同护理服务的VA办公室合作。提出了四个项目，都集中在改善提供以退伍军人为中心的护理。这些项目将在退伍军人健康管理局的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）和家庭初级保健方案中进行。他们都是为了支持一个新的计划，要求退伍军人在这些设置有关他们的护理偏好，特别是医疗保健服务和干预措施，通常用于在危及生命的紧急情况下，或生命维持措施。这些措施包括但不限于心脏复苏、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维持生命的治疗，还包括他们是否想在急性病时住院，他们想接受什么样的舒适护理，以及他们想体验什么样的身体活动，即使在生命的尽头。这四个项目都是质量改进项目。两个重点是实施新的方法来询问对护理的偏好，并确保这些偏好被记录在每个为退伍军人提供护理的人都可以找到的地方。一个侧重于在社区生活中心实施这种新方法，另一个侧重于进入退伍军人之家提供护理的护理提供者团队之间的类似工作。两人都在这些环境中与工作人员跟进，以确保退伍军人表达的偏好被纳入他们所接受的服务。另外两个项目的重点是如何改善对老年痴呆症（如阿尔茨海默病）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，并住在社区生活中心或家中接受VA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满足期望的程度，并按预期记录他们。我们还将使用所谓的“学习协作者”--员工团队聚在一起开会，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。我们将使用一段时间内的数据，看看我们所做的工作是否有改进。我们将与我们的业务伙伴合作，在整个退伍军人健康管理局推广有效的方法。

 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.