Evaluating Feedback Reports to Support Documentation of Veterans' Care Preferences in Home Based Primary Care

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2024 May 1

PMID 38693502

Authors

Cari Levy

Jennifer Kononowech

Mary Ersek

Ciaran S Phibbs

Winifred Scott

Anne Sales

Affiliations

Soon will be listed here.

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.

References

Landis-Lewis Z, Kononowech J, Scott W, Hogikyan R, Carpenter J, Periyakoil V . Designing clinical practice feedback reports: three steps illustrated in Veterans Health Affairs long-term care facilities and programs. Implement Sci. 2020; 15(1):7. PMC: 6975062. DOI: 10.1186/s13012-019-0950-y. View

Ersek M, Sales A, Keddem S, Ayele R, Haverhals L, Magid K . Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED): a protocol for an implementation study in the Veterans Health Administration. Implement Sci Commun. 2022; 3(1):78. PMC: 9296899. DOI: 10.1186/s43058-022-00321-2. View

Kirchner J, Smith J, Powell B, Waltz T, Proctor E . Getting a clinical innovation into practice: An introduction to implementation strategies. Psychiatry Res. 2019; 283:112467. PMC: 7239693. DOI: 10.1016/j.psychres.2019.06.042. View

Byrne M, Daw C, Nelson H, Urech T, Pietz K, Petersen L . Method to develop health care peer groups for quality and financial comparisons across hospitals. Health Serv Res. 2009; 44(2 Pt 1):577-92. PMC: 2677055. DOI: 10.1111/j.1475-6773.2008.00916.x. View

Foglia M, Lowery J, Sharpe V, Tompkins P, Fox E . A Comprehensive Approach to Eliciting, Documenting, and Honoring Patient Wishes for Care Near the End of Life: The Veterans Health Administration's Life-Sustaining Treatment Decisions Initiative. Jt Comm J Qual Patient Saf. 2018; 45(1):47-56. DOI: 10.1016/j.jcjq.2018.04.007. View

Hysong S . Meta-analysis: audit and feedback features impact effectiveness on care quality. Med Care. 2009; 47(3):356-63. PMC: 4170834. DOI: 10.1097/MLR.0b013e3181893f6b. View

Wang L, Porter B, Maynard C, Evans G, Bryson C, Sun H . Predicting risk of hospitalization or death among patients receiving primary care in the Veterans Health Administration. Med Care. 2012; 51(4):368-73. DOI: 10.1097/MLR.0b013e31827da95a. View

Chang E, Buist D, Handley M, Johnson E, Fuller S, Pardee R . Primary care physician resource use changes associated with feedback reports. Am J Manag Care. 2018; 24(10):455-461. View

Ruiz J, Priyadarshni S, Rahaman Z, Cabrera K, Dang S, Valencia W . Validation of an automatically generated screening score for frailty: the care assessment need (CAN) score. BMC Geriatr. 2018; 18(1):106. PMC: 5935952. DOI: 10.1186/s12877-018-0802-7. View

10.

Ivers N, Sales A, Colquhoun H, Michie S, Foy R, Francis J . No more 'business as usual' with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implement Sci. 2014; 9:14. PMC: 3896824. DOI: 10.1186/1748-5908-9-14. View

11.

Kinosian B, Wieland D, Gu X, Stallard E, Phibbs C, Intrator O . Validation of the JEN frailty index in the National Long-Term Care Survey community population: identifying functionally impaired older adults from claims data. BMC Health Serv Res. 2018; 18(1):908. PMC: 6267903. DOI: 10.1186/s12913-018-3689-2. View

12.

Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J . Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009; 4:50. PMC: 2736161. DOI: 10.1186/1748-5908-4-50. View

13.

Salehi L, Jaskolka J, Yu H, Ossip M, Phalpher P, Valani R . The impact of performance feedback reports on physician ordering behavior in the use of computed tomography pulmonary angiography (CTPA). Emerg Radiol. 2022; 30(1):63-69. PMC: 9664050. DOI: 10.1007/s10140-022-02100-x. View

14.

Chang C, Jackson S, Bullman T, Cobbs E . Impact of a home-based primary care program in an urban Veterans Affairs medical center. J Am Med Dir Assoc. 2009; 10(2):133-7. DOI: 10.1016/j.jamda.2008.08.002. View

15.

Levy C, Ersek M, Scott W, Carpenter J, Kononowech J, Phibbs C . Life-Sustaining Treatment Decisions Initiative: Early Implementation Results of a National Veterans Affairs Program to Honor Veterans' Care Preferences. J Gen Intern Med. 2020; 35(6):1803-1812. PMC: 7280392. DOI: 10.1007/s11606-020-05697-2. View

16.

Hysong S, Kell H, Petersen L, Campbell B, Trautner B . Theory-based and evidence-based design of audit and feedback programmes: examples from two clinical intervention studies. BMJ Qual Saf. 2016; 26(4):323-334. DOI: 10.1136/bmjqs-2015-004796. View

17.

Beales J, Edes T . Veteran's Affairs Home Based Primary Care. Clin Geriatr Med. 2009; 25(1):149-54, viii-ix. DOI: 10.1016/j.cger.2008.11.002. View

18.

Carpenter J, Scott W, Kononowech J, Foglia M, Haverhals L, Hogikyan R . Evaluating implementation strategies to support documentation of veterans' care preferences. Health Serv Res. 2022; 57(4):734-743. PMC: 9264454. DOI: 10.1111/1475-6773.13958. View

19.

Harvey G, Kitson A . PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implement Sci. 2016; 11:33. PMC: 4807546. DOI: 10.1186/s13012-016-0398-2. View

20.

Colquhoun H, Brehaut J, Sales A, Ivers N, Grimshaw J, Michie S . A systematic review of the use of theory in randomized controlled trials of audit and feedback. Implement Sci. 2013; 8:66. PMC: 3702512. DOI: 10.1186/1748-5908-8-66. View