Denver-Seattle VA Center of Innovation for Value Driven & Veteran-Centric Care, Rocky Mountain Regional VA Medical Center at VA Eastern Colorado Health Care System, Aurora, CO, USA.
Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
BMC Geriatr. 2024 May 1;24(1):389. doi: 10.1186/s12877-024-04999-y.
To evaluate the effectiveness of delivering feedback reports to increase completion of LST notes among VA Home Based Primary Care (HBPC) teams. The Life Sustaining Treatment Decisions Initiative (LSTDI) was implemented throughout the Veterans Health Administration (VHA) in the United States in 2017 to ensure that seriously ill Veterans have care goals and LST decisions elicited and documented.
We distributed monthly feedback reports summarizing LST template completion rates to 13 HBPC intervention sites between October 2018 and February 2020 as the sole implementation strategy. We used principal component analyses to match intervention to 26 comparison sites and used interrupted time series/segmented regression analyses to evaluate the differences in LST template completion rates between intervention and comparison sites. Data were extracted from national databases for VA HBPC in addition to interviews and surveys in a mixed methods process evaluation.
LST template completion rose from 6.3 to 41.9% across both intervention and comparison HBPC teams between March 1, 2018, and February 26, 2020. There were no statistically significant differences for intervention sites that received feedback reports.
Feedback reports did not increase documentation of LST preferences for Veterans at intervention compared with comparison sites. Observed increases in completion rates across intervention and comparison sites can likely be attributed to implementation strategies used nationally as part of the national roll-out of the LSTDI. Our results suggest that feedback reports alone were not an effective implementation strategy to augment national implementation strategies in HBPC teams.
评估反馈报告的有效性，以提高退伍军人事务部家庭为基础的初级保健 (HBPC) 团队完成生命维持治疗 (LST) 记录的比例。2017 年，美国退伍军人事务部 (VHA) 在全美范围内实施了生命维持治疗决策倡议 (LSTDI)，以确保重病退伍军人有明确的护理目标，并对生命维持治疗决策进行评估和记录。
我们在 2018 年 10 月至 2020 年 2 月期间，向 13 个 HBPC 干预站点每月分发一份反馈报告，总结 LST 模板完成率，作为唯一的实施策略。我们使用主成分分析将干预组与 26 个对照组相匹配，并使用中断时间序列/分段回归分析评估干预组和对照组之间 LST 模板完成率的差异。除了混合方法过程评估中的访谈和调查外，数据还从国家退伍军人事务部 HBPC 数据库中提取。
2018 年 3 月 1 日至 2020 年 2 月 26 日，干预组和对照组的 HBPC 团队的 LST 模板完成率从 6.3%上升至 41.9%。收到反馈报告的干预站点没有统计学上的显著差异。
与对照组相比，反馈报告并没有增加退伍军人 LST 偏好的记录。干预组和对照组的完成率均有所上升，这可能归因于作为 LSTDI 全国推广的一部分而在全国范围内使用的实施策略。我们的研究结果表明，仅反馈报告本身并不是增强 HBPC 团队全国实施策略的有效实施策略。
