PDF(Pubmed)
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.
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.
摘要：
背景：评估提供反馈报告以提高VA家庭基础初级保健（HBPC）团队完成LST注释的有效性。生命维持治疗决定计划（LSTDI）于2017年在美国整个退伍军人健康管理局（VHA）实施，以确保重病退伍军人有护理目标，并引发并记录LST决定。
方法：我们在2018年10月至2020年2月期间向13个HBPC干预地点分发了总结LST模板完成率的月度反馈报告，作为唯一的实施策略。我们使用主成分分析将干预与26个比较站点进行匹配，并使用中断时间序列/分段回归分析来评估干预站点和比较站点之间LST模板完成率的差异。除了在混合方法过程评估中进行访谈和调查外，数据还从VAHBPC的国家数据库中提取。
结果：在2018年3月1日至2020年2月26日期间，干预和比较HBPC团队的LST模板完成率从6.3％上升到41.9％。收到反馈报告的干预部位没有统计学上的显着差异。
结论：反馈报告并没有增加退伍军人在干预时对LST偏好的记录，与比较站点相比。观察到的干预和比较地点的完成率增加可能归因于在全国范围内作为LSTDI推广的一部分而在全国范围内使用的实施战略。我们的结果表明，仅反馈报告并不是增强HBPC团队国家实施战略的有效实施战略。
方法：我们在2018年10月至2020年2月期间向13个HBPC干预地点分发了总结LST模板完成率的月度反馈报告，作为唯一的实施策略。我们使用主成分分析将干预与26个比较站点进行匹配，并使用中断时间序列/分段回归分析来评估干预站点和比较站点之间LST模板完成率的差异。除了在混合方法过程评估中进行访谈和调查外，数据还从VAHBPC的国家数据库中提取。
结果：在2018年3月1日至2020年2月26日期间，干预和比较HBPC团队的LST模板完成率从6.3％上升到41.9％。收到反馈报告的干预部位没有统计学上的显着差异。
结论：反馈报告并没有增加退伍军人在干预时对LST偏好的记录，与比较站点相比。观察到的干预和比较地点的完成率增加可能归因于在全国范围内作为LSTDI推广的一部分而在全国范围内使用的实施战略。我们的结果表明，仅反馈报告并不是增强HBPC团队国家实施战略的有效实施战略。
