Department of Veteran Affairs Gold Status Practice—Advance Care Planning Using Group Visits (QI711)

Abstract

•Describe key components of advance care planning group visits, including social worker and team-based facilitation, clinic-based needs, and staffing resources.•Obtain person-centered tools and communication skills to successfully facilitate advance care planning group visits. Advance care planning (ACP) is a health behavior that requires person-centered education, support by trained professionals and motivational strategies to promote goal-setting and actions. Group visits in the healthcare setting can effectively increase an individual’s knowledge, motivation and self-efficacy. This session presents a best practice and lessons learned from implementation of group visits focused on ACP. To improve care delivery for our nation’s Veterans, the Department of Veterans Affairs (VA) developed the Diffusion of Excellence Initiative to identify and spread practices developed through quality improvement methods. One such practice is Advance Care Planning via Group Visits (ACP-GV), which uses an interactive and patient-centered group session to engage Veterans in thinking about and planning for future medical decisions. In these sessions, social workers, or other health professionals, facilitate discussions for Veterans and their trusted others. Facilitators emphasize that while completing an advance directive is voluntary, it increases the chance that their care aligns with their wishes and values and relieves trusted others of having to make these difficult decisions. In addition, ACP-GV increases the effectiveness of advance care planning through allowing Veterans to discuss and process these complex topics with other Veterans in a group session. To date, 34 VA Medical Centers (VAMCs) have adopted the ACP-GV practice and more than 10,250 Veterans have attended ACP-GV sessions. Of those participants, approximately 18-20% developed a new advance care directive within one month of the session, and 86% set a smart goal to take additional steps toward advance care planning. Continued rollout of this innovative practice to VAMCs across the nation is ongoing. At the conclusion of the session, attendees will have practical guidance, techniques and tools for implementation of ACP discussions using group visits in integrated (VA) or fee-for-service (Medicare) outpatient settings.