Haverhals Leah M, Magid Kate H, Kononowech Jennifer
Denver-Seattle VA Center of Innovation for Value Driven and Veteran-Centric Care, Rocky Mountain Regional VA Medical Center at VA Eastern Colorado Health Care System, Aurora, CO, United States.
Health Care Policy and Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Front Health Serv. 2022 Sep 2;2:935341. doi: 10.3389/frhs.2022.935341. eCollection 2022.
In 2017, the National Center for Ethics in Health Care for the United States Department of Veterans Affairs (VA) commenced national roll-out of the Life-Sustaining Treatment Decisions Initiative. This national VA initiative aimed to promote personalized, proactive, patient-driven care for seriously ill Veterans by documenting Veterans' goals and preferences for life-sustaining treatments in a durable electronic health record note template known as the life-sustaining treatment template. The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED) quality improvement program was created to address the high variation in life-sustaining treatment template completion in VA Home Based Primary Care (HBPC) and Community Nursing Home programs. This manuscript describes the program that focuses on improving life sustaining treatment template completion rates amongst HBPC programs. To increase life-sustaining treatment template completion for Veterans receiving care from HBPC programs, the PERSIVED team applies two implementation strategies: audit with feedback and implementation facilitation. The PERSIVED team conducts semi-structured interviews, needs assessments, and process mapping with HBPC programs in order to identify barriers and facilitators to life-sustaining treatment template completion to inform tailored facilitation. Our interview data is analyzed using the Tailored Implementation in Chronic Diseases (TICD) framework, which identifies 57 determinants that might influence practice or implementation of interventions. To quickly synthesize and use baseline data to inform the tailored implementation plan, we adapted a rapid analysis process for our purposes. This paper describes a six-step process for conducting and analyzing baseline interviews through applying the TICD that can be applied and adapted by implementation scientists to rapidly inform tailoring of implementation facilitation.
2017年，美国退伍军人事务部国家医疗保健伦理中心启动了维持生命治疗决策倡议的全国推广。这项退伍军人事务部的全国性倡议旨在通过在一种名为维持生命治疗模板的持久电子健康记录笔记模板中记录退伍军人对维持生命治疗的目标和偏好，来促进为重症退伍军人提供个性化、积极主动、以患者为导向的护理。通过强化决策制定对重症退伍军人的偏好进行引出和尊重（PERSIVED）质量改进计划的设立，是为了解决退伍军人事务部家庭初级保健（HBPC）和社区疗养院项目中维持生命治疗模板填写情况差异较大的问题。本文描述了该计划，其重点是提高HBPC项目中维持生命治疗模板的填写率。为了提高接受HBPC项目护理的退伍军人的维持生命治疗模板填写率，PERSIVED团队采用了两种实施策略：带反馈的审核和实施促进。PERSIVED团队与HBPC项目进行半结构化访谈、需求评估和流程映射，以确定维持生命治疗模板填写的障碍和促进因素，为量身定制的促进措施提供信息。我们使用慢性病定制实施（TICD）框架对访谈数据进行分析，该框架确定了57个可能影响干预措施实施或执行的决定因素。为了快速综合并利用基线数据为量身定制的实施计划提供信息，我们为自己的目的改编了一个快速分析过程。本文描述了一个通过应用TICD进行基线访谈并分析的六步过程，实施科学家可以应用和改编该过程，以迅速为实施促进的量身定制提供信息。
