Implementing Goals of Care Conversations with Veterans in VA LTC Settings

 描述(由申请人提供)： “在退伍军人长期护理服务环境中与退伍军人实施护理对话的目标”计划是与退伍军人健康护理伦理全国中心、老年医学和延伸护理计划办公室以及退伍军人护理服务办公室合作提出的。提出了四个项目，都侧重于改善以退伍军人为中心的护理提供。这些项目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养老院)和以家庭为基础的初级保健计划中进行。它们都是为了支持一项新的计划，向这些环境中的退伍军人询问他们对护理的偏好，特别是在发生危及生命的紧急情况或维持生命的措施时通常使用的医疗保健服务和干预措施。这些措施包括但不限于心脏复苏、机械通风和其他形式的生命支持。然而，退伍军人对护理的偏好不仅仅是他们是否接受维持生命的治疗，还包括他们是否想在病情危重时住院，他们想要接受什么样的舒适护理，以及他们想要经历什么样的体力活动，即使是在生命即将结束的时候。这四个项目都是作为质量改进项目来规划的。两个重点是实施新的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它们。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开展类似的工作。这两家公司都在这些环境中与工作人员进行跟进，以确保退伍军人表达的偏好被纳入他们所获得的服务中。另外两个项目侧重于如何改善对阿尔茨海默氏症等痴呆症退伍军人的护理，以及如何增加退伍军人在生命接近尾声时提供的体力活动数量，并居住在社区生活中心或家中接受退伍军人管理局的服务。在所有项目中，我们将使用信息为员工设计反馈报告，帮助他们了解他们在询问退伍军人的偏好方面达到预期的情况如何，并按照预期记录他们的偏好。我们还将使用所谓的“学习协作”--员工团队聚集在一起，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行动方面遇到的问题的会议。随着时间的推移，我们将使用数据来查看在我们所做的工作之后是否有改进。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。

 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.