Abstract: (Withdrawn) Advance Care Planning Via Group Visits: An Innovative Approach to Implementing and Evaluating an Age-Friendly Program in the Department of Veterans Affairs (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)

All in-person and virtual presentations are in Mountain Standard Time Zone (MST).

SSWR 2023 Poster Gallery: as a registered in-person and virtual attendee, you have access to the virtual Poster Gallery which includes only the posters that elected to present virtually. The rest of the posters are presented in-person in the Poster/Exhibit Hall located in Phoenix A/B, 3rd floor. The access to the Poster Gallery will be available via the virtual conference platform the week of January 9. You will receive an email with instructions how to access the virtual conference platform.

65P (Withdrawn) Advance Care Planning Via Group Visits: An Innovative Approach to Implementing and Evaluating an Age-Friendly Program in the Department of Veterans Affairs

Thursday, January 12, 2023
Phoenix C, 3rd Level (Sheraton Phoenix Downtown)
* noted as presenting author
Monica Matthieu, PhD, Professor, Saint Louis University and Department of Veterans Affairs, Central Arkansas Veterans Healthcare System, St. Louis, MO
Laura Taylor, MSW, National Field Based Facilitator, Department of Veterans Affairs, Central Arkansas Veterans Healthcare System, Little Rock, AR
Songthip Ounpraseuth, PhD, Statistician, University of Arkansas for Medical Sciences
James S. Williams, BS, Programmer, Department of Veterans Affairs Central Arkansas VA Healthcare System
Bo Hu, MS, Programmer, University of Arkansas Medical Sciences
Ciara Oliver, BS, Health Science Specialist, Department of Veterans Affairs, Central Arkansas Veterans Healthcare System, North Little Rock, AR
David Adkins, MHA, Research Health Science Specialist, Department of Veterans Affairs
Ian Smith, BS, Program Analyst, Department of Veterans Affairs, AR
Jane Ann McCullough, MSW, ACP-GV National Program Coordinator, Department of Veterans Affairs, AR
Kimberly Garner, MD, JD, Physician, Program Lead, Senior Author, Department of Veterans Affairs
Background and Purpose. The U.S. population aged 65+ is expected to nearly double over the next 30 years, reaching an estimated 83.7 million by 2050. Due to the growth and longevity of this population, health care organizations are challenged to ensure they are providing quality care to this burgeoning population of older adults. By mission, the Veterans Health Administration (VHA) delivers health care to adult beneficiaries that served in the U.S. uniformed services across the age continuum. This paper focuses on an innovative Department of Veterans Affairs (VA) health care program, Advance Care Planning (ACP) via Group Visits (ACP-GV), and how the program operationalizes one of four evidence-based elements of a high quality care framework, known as the “4Ms,” to identify as an Age-Friendly Healthcare System for its 9.16 million beneficiaries. As one effort to address health disparities, gaps, and inequities in care for veterans in rural areas and to improve the access to and the experience of care, ACP-GV, a multi-year Office of Rural Health Enterprise-Wide Initiative, integrates ACP into rural medical centers and clinics. ACP-GV engages veterans, their families, and caregivers in ACP by facilitating a group discussion that elicits personal experience(s) and encourages participants to identify a ‘next step’ to take in planning for future care needs. Therefore, the objectives of this presentation are to identify patient characteristics, impacts, and lessons learned associated with veteran participation in ACP within VHA.

Methods. Primary and secondary data were collected from VHA during fiscal years 2020-2021 for a mixed methodology Quality Enhancement Research Initiative (QUERI) funded partnered national program evaluation of ACP-GV. Cross-sectional examination of the profile of veterans and access to ACP were obtained from VHA administrative data. Key quantitative variables include individual Advance Directive (AD) discussions, ACP-GV attendance, and other measures such as age, unique patient identifiers, geographic characteristics, and provider-level data of electronic health record note titles indicating type of ACP participation. Qualitative interviews gathered age-related impacts on veterans and families while lessons learned in implementing ACP-GV across the full range of VHA care settings were content analyzed using existing program materials (e.g., strategic plans, annual reports).

Results. VHA is generally more successful in reaching veterans with AD discussions for ages 55-64 years old and 65-74 years old, while ACP-GV is reaching all veterans under age 75. Neither approach adequately reaches veterans over age 75, yet programmatic lessons learned reveal that partnerships with national programs, such as Caregiver Support, can enhance opportunities for reducing age-related inequities in accessing ACP and identifying What Matters, one of the 4Ms. Veteran impacts include gratitude for offering ACP-GV, amid initial hesitations to attend, and generally well-received inclusion of families and caregivers.

Conclusions and Implications. As a national program that aligns with What Matters in the 4Ms framework, ACP-GV as an Age-Friendly program plans to strategically engage veterans over age 75 with the value-based propositions and action steps that lead to enhanced planning and documentation of their care preferences.