(Withdrawn) Advance Care Planning Via Group Visits: An Innovative Approach to Implementing and Evaluating an Age-Friendly Program in the Department of Veterans Affairs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