Monday, July 15, 2024

New VA Initiative Examines Impact of Life-Sustaining Treatment Documentation on End-of-Life Care

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The Veterans Health Administration (VA) has implemented the Life-Sustaining Treatment (LST) Decisions Initiative to standardize documentation of end-of-life care preferences for seriously ill Veterans. This initiative aims to improve outcomes and ensure that Veterans’ wishes are respected. A recent study scrutinized the correlation between LST documentation and the quality of care as evaluated by families during the last month of life for Veterans in VA nursing homes.

Study Methods and Sample

Conducted as a retrospective, cross-sectional analysis, the study included data from 14,575 deceased Veterans in VA nursing homes between July 1, 2018, and January 31, 2020. Regression models were used to calculate the odds of key end-of-life outcomes and family ratings of care quality. Market access considerations highlight the importance of standardizing practices to ensure equitable care across diverse settings.

Key Findings

The findings revealed that LST preferences were documented for 89% of the decedents. Interestingly, the analysis showed no significant differences in the receipt of desired medications and treatments or in family ratings of overall care quality between those with and without completed LST templates. This raises questions about whether other factors might play a more crucial role in perceived care quality at the end of life.

The study’s revelations are significant for market access in healthcare, as they underscore the need for comprehensive strategies beyond mere documentation. The results suggest that while standardizing documentation is essential, it is not the sole factor influencing care quality as perceived by families.

Implications for Policy and Practice

  • Standardizing LST documentation ensures equitable access to care preferences.
  • Other factors, including staff training and care environment, may impact family ratings of care quality.
  • Further research is necessary to identify additional elements that could enhance end-of-life care satisfaction.

The study concludes that focusing solely on LST documentation may not suffice to improve family perceptions of end-of-life care quality. Future interventions should address a broader range of factors to enhance the overall care experience in VA nursing homes.

Original Article:

J Am Geriatr Soc. 2024 Jul 6. doi: 10.1111/jgs.19050. Online ahead of print.

ABSTRACT

BACKGROUND: Modeled after the Physician Orders for Life Sustaining Treatment program, the Veterans Health Administration (VA) implemented the Life-Sustaining Treatment (LST) Decisions Initiative to improve end-of-life outcomes by standardizing LST preference documentation for seriously ill Veterans. This study examined the associations between LST documentation and family evaluation of care in the final month of life for Veterans in VA nursing homes.

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METHODS: Retrospective, cross-sectional analysis of data for decedents in VA nursing homes between July 1, 2018 and January 31, 2020 (N = 14,575). Regression modeling generated odds for key end-of-life outcomes and family ratings of care quality.

RESULTS: LST preferences were documented for 12,928 (89%) of VA nursing home decedents. Contrary to our hypothesis, neither receipt of wanted medications and medical treatment (adjusted odds ratio [OR]: 0.85, 95% confidence interval [CI] 0.63, 1.16) nor ratings of overall care in the last month of life (adjusted OR: 0.96, 95% CI 0.76, 1.22) differed significantly between those with and without completed LST templates in adjusted analyses.

CONCLUSIONS: Among Community Living Center (CLC) decedents, 89% had documented LST preferences. No significant differences were observed in family ratings of care between Veterans with and without documentation of LST preferences. Interventions aimed at improving family ratings of end-of-life care quality in CLCs should not target LST documentation in isolation of other factors associated with higher family ratings of end-of-life care quality.

PMID:38970392 | DOI:10.1111/jgs.19050

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