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. 2024 May 1;24(1):389.
doi: 10.1186/s12877-024-04999-y.

Evaluating feedback reports to support documentation of veterans' care preferences in home based primary care

Cari Levy  1   2 , Jennifer Kononowech  3 , Mary Ersek  4   5 , Ciaran S Phibbs  6   7 , Winifred Scott  6 , Anne Sales  8   9
Affiliations

Evaluating feedback reports to support documentation of veterans' care preferences in home based primary care

Cari Levy et al. BMC Geriatr. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Advance care planning; Department of Veterans affairs; Implementation science; Interrupted time series analysis; Nursing homes; Veteran.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Intervention vs. Comparison Data: Percent of HBPC Admissions with Life-Sustaining Treatment Documentation Completed During the 1st or 2nd HBPC Visit or Prior to Admission by Bi-Weekly Interval
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