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.