Haverfield Marie C, Garcia Ariadna, Giannitrapani Karleen F, Walling Anne, Rigdon Joseph, Bekelman David B, Lo Natalie, Lehmann Lisa S, Jacobs Josephine, Festa Natalia, Lorenz Karl A
VA Palo Alto, Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA; Department of Communication Studies, San José State University, San Jose, California, USA.
VA Palo Alto, Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA; School of Medicine, Stanford University, Stanford, California, USA.
J Pain Symptom Manage. 2022 Apr;63(4):485-494. doi: 10.1016/j.jpainsymman.2021.12.023. Epub 2021 Dec 22.
The Life Sustaining Treatment Decision Initiative is a national effort by the Veterans Health Administration to ensure goals of care documentation occurs among all patients at high risk of life-threatening events.
Examine likelihood to receive goals of care documentation and explore associations between documentation and perceived patient care experience at the individual and site level.
Retrospective, quality improvement analysis of initiative pilot data from four geographically diverse Veterans Affairs (VA) sites (Fall 2014-Winter 2016) before national roll-out. Goals of care documentation according to gender, marital status, urban/rural status, race/ethnicity, age, serious health condition, and Care Assessment Needs scores. Association between goals of care documentation and perceived patient care experience analyzed based on Bereaved Family Survey outcomes of overall care, communication, and support.
Veterans were more likely to have goals of care documentation if widowed, urban residents, and of white race. Patients older than 65-years and those with a higher Care Assessment Needs score were twice as likely as a frail patient to have goals of care documented. One pilot site demonstrated a positive association between documentation and perceived support. Pilot site was a statistically significant predictor of the occurrence of goals of care documentation and Bereaved Family Survey scores.
Older and seriously ill patients were most likely to have goals of care documented. Association between a documented goals of care conversation and perceived patient care experience were largely unsupported. Site-level largely contributed to understanding the likelihood of documentation and care experience.
维持生命治疗决策倡议是退伍军人健康管理局在全国范围内开展的一项工作，旨在确保在所有面临危及生命事件高风险的患者中进行护理目标记录。
研究接受护理目标记录的可能性，并在个体和机构层面探讨记录与患者感知护理体验之间的关联。
对全国推广之前来自四个地理位置不同的退伍军人事务（VA）机构（2014年秋季至2016年冬季）的倡议试点数据进行回顾性质量改进分析。根据性别、婚姻状况、城乡状况、种族/民族、年龄、严重健康状况和护理评估需求得分进行护理目标记录。基于丧亲家庭对整体护理、沟通和支持的调查结果，分析护理目标记录与患者感知护理体验之间的关联。
丧偶、城市居民和白人退伍军人更有可能有护理目标记录。65岁以上的患者和护理评估需求得分较高的患者进行护理目标记录的可能性是体弱患者的两倍。一个试点机构表明记录与感知支持之间存在正相关。试点机构是护理目标记录发生情况和丧亲家庭调查得分的统计学显著预测因素。
年龄较大和病情严重的患者最有可能有护理目标记录。护理目标对话记录与患者感知护理体验之间的关联在很大程度上未得到支持。机构层面在很大程度上有助于理解记录的可能性和护理体验。
