Life-Sustaining Treatment Decisions Initiative: Early Implementation Results of a National Veterans Affairs Program to Honor Veterans’ Care Preferences
Autor: | Joan G. Carpenter, Marybeth Foglia, Cari Levy, Winifred Scott, Ciaran S. Phibbs, Jill Lowry, Jennifer H. Cohen, Mary Ersek, Jennifer Kononowech |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Documentation 01 natural sciences 03 medical and health sciences 0302 clinical medicine Quality of life (healthcare) Health care Internal Medicine medicine Humans 030212 general & internal medicine 0101 mathematics Veterans Affairs Aged Retrospective Studies Veterans Original Research Receipt Terminal Care business.industry 010102 general mathematics Retrospective cohort study medicine.disease Comorbidity United States United States Department of Veterans Affairs Family medicine Quality of Life Residence business |
Zdroj: | J Gen Intern Med |
ISSN: | 1525-1497 0884-8734 |
Popis: | BACKGROUND: On July 1, 2018, the Veterans Health Administration (VA) National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative (LSTDI). Its goal is to identify, document, and honor LST decisions of seriously ill veterans. Providers document veterans’ goals and decisions using a standardized LST template and order set. OBJECTIVE: Evaluate the first 7 months of LSTDI implementation and identify predictors of LST template completion. DESIGN: Retrospective observational study of clinical and administrative data. We identified all completed LST templates, defined as completion of four required template fields. Templates also include four non-required fields. Results were stratified by risk of hospitalization or death as estimated by the Care Assessment Need (CAN) score. SUBJECTS: All veterans with VA utilization between July 1, 2018, and January 31, 2019. MAIN MEASURES: Completed LST templates, goals and LST preferences, and predictors of documentation. RESULTS: LST templates were documented for 108,145 veterans, and 85% had one or more of the non-required fields completed in addition to the required fields. Approximately half documented a preference for cardiopulmonary resuscitation. Among those who documented specific goals, half wanted to improve or maintain function, independence, and quality of life while 28% had a goal of life prolongation irrespective of risk of hospitalization/death and 45% expressed a goal of comfort. Only 7% expressed a goal of being cured. Predictors of documentation included VA nursing home residence, older age, frailty, and comorbidity, while non-Caucasian race, rural residence, and receipt of care in a lower complexity medical center were predictive of no documentation. CONCLUSIONS: LST decisions were documented for veterans at high risk of hospitalization or death. While few expressed a preference for cure, half desire, cardiopulmonary resuscitation. Predictors of documentation were generally consistent with existing literature. Opportunities to reduce observed disparities exist by leveraging available VA resources and programs. |
Databáze: | OpenAIRE |
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