Goals of Care Documentation: Insights from A Pilot Implementation Study.

Area of Science:

• Healthcare Quality Improvement
• Patient-Centered Care
• Health Services Research

Background:

• The Veterans Health Administration's Life Sustaining Treatment Decision Initiative aims to improve goals of care documentation for high-risk patients.
• Ensuring comprehensive documentation of end-of-life care preferences is crucial for patient autonomy and quality of care.

Purpose of the Study:

• To assess the likelihood of goals of care documentation among diverse veteran populations.
• To investigate the relationship between documented goals of care and patients' perceived care experiences at both individual and facility levels.

Main Methods:

• A retrospective quality improvement analysis was conducted using pilot data from four Veterans Affairs (VA) sites.
• Data were analyzed for associations between documentation and demographic factors, health status, and Care Assessment Needs (CAN) scores.
• The link between documentation and patient care experience was evaluated using Bereaved Family Survey outcomes.

Main Results:

• Veterans who were widowed, lived in urban areas, or were of white race were more likely to have goals of care documented.
• Older patients (over 65) and those with higher CAN scores were twice as likely to have documentation compared to frail patients.
• A positive association between documentation and perceived support was observed at one pilot site, which also predicted documentation rates and survey scores.

Conclusions:

• Older and seriously ill veterans were more likely to have goals of care documented.
• The association between documented goals of care conversations and perceived patient care experience was generally not supported.
• Site-level factors played a significant role in both the likelihood of documentation and the reported patient care experience.