5008 — Advance Care Planning and Healthcare Equity

Lead/Presenter: David Adkins, 
All Authors: Matthieu MM (Central Arkansas Veterans Healthcare System, HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research, Saint Louis University) Oliver CM (Central Arkansas Veterans Healthcare System, HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research) Smith, ID (Central Arkansas Veterans Healthcare System, HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research) Taylor, LD (Central Arkansas Veterans Healthcare System, Geriatric Research, Education and Clinical Center) McCullough JA (Central Arkansas Veterans Healthcare System, Geriatric Research, Education and Clinical Center) Mallory MJ (Central Arkansas Veterans Healthcare System, Geriatric Research, Education and Clinical Center) Garner, KK (Central Arkansas Veterans Healthcare System, Geriatric Research, Education and Clinical Center, University of Arkansas for Medical Sciences, College of Medicine)

Objectives:
The objective of Advance Care Planning via Group Visits (ACP-GV) is to promote and integrate veteran engagement from the conceptualization to the dissemination of the Quality Enhancement Research Initiative (QUERI) funded national program evaluation of the VHA’s Diffusion of Excellence Initiative on ACP-GV.

Methods:
Providing timely and equitable high-quality health care, beginning with their transition from military service and throughout the rest of the veteran’s life, is a cornerstone principle of the Veterans Healthcare Administration (VHA). To ensure veteran’s care wishes are honored should they be unable to communicate for themselves is the goal of the ACP-GV initiative. It is estimated that 6.7 of the 9.16 million veterans enrolled in VHA do not have an Advance Directive (AD) on file (Roe et al., 2014). ACP-GV is one program currently under evaluation to increase awareness of ACP and encourage veterans to complete an AD. The group format allows the facilitator to engage a group of up to ten veterans, their families, and caregivers in a facilitated discussion about ACP. This discussion educates veterans on their options for life-sustaining treatment, and other critical medical decisions.

Results:
ACP-GV has been implemented in over 70 VHA facilities, with the goal of enterprise-wide national implementation. As a 30-year retiree from the United States Air Force where I served as a Chief Master Sergeant, my role as the QUERI ACP-GV Project Manager is to coordinate all program evaluation tasks and oversee the project’s timeline, data collection, and data quality processes, as well as manage the project budget. As a veteran, I seek to provide the veteran’s perspective on outreach and marketing materials, program goals, and objectives, as well as helping to develop clear, relevant, and non-redundant data collection tools. Using a mixed-methods evaluation design, data has been collected that indicates ACP-GV is being delivered to veterans across various ages, racial ethnicities, and gender populations (Matthieu, et al., 2020, 2022, in press). A current unanswered question is whether the program is meeting the needs of all veterans, especially those who belong to historically underserved or marginalized populations. The national implementation team has initiated a partnership with other national programs such as Blind Rehabilitative, LGBTQ+, and Homeless services. These partnerships led to the creation of a data collection tool that I collaboratively designed with the team to assess ACP-GV’s engagement activities more discretely and at the various stages of diffusion (e.g., exploration, adoption, implementation, sustainment).

Implications:
It is hoped that the data will reflect increased access and equity to ACP and to allow the team to make programmatic adjustments if indicated.

Impacts:
This program is important as veterans deserve to access to equitable healthcare that respects their unique medical needs and decisions should they become unable to communicate for themselves.