Life-Sustaining Treatment Decisions Initiative (LSTDI)
Last updated
Share PrintThe Life-Sustaining Treatment Decisions Initiative (LSTDI) is a national VHA quality improvement project that promotes personalized, proactive, patient-driven care for Veterans with serious illness by eliciting, documenting, and honoring their values, goals, and life-sustaining treatment decisions.
Origin:
January 2017, VHA National Center for Ethics in Health Care
Adoptions:
5 successful
Partners:
Quality Enhancement Research Initiative
Recent Updates
Overview
The problem
Conversations about goals of care and life-sustaining treatment (LST) decisions are often initiated too late in the course of serious illness: either after a medical crisis or loss of decision-making capacity. Even when goals of care conversations occurred, locating the most current documentation was difficult due to the lack of standardized documentation pr
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Conversations about goals of care and life-sustaining treatment (LST) decisions are often initiated too late in the course of serious illness: either after a medical crisis or loss of decision-making capacity. Even when goals of care conversations occurred, locating the most current documentation was difficult due to the lack of standardized documentation practices and templates.
See
more
Files
- Publication which describes the Life-Sustaining Treatment Decisions Initiative Life-Sustaining Treatment Decisions Initiative Manuscript
The solution
VHA Handbook 1004.03 (LST Handbook) was developed to standardize processes related to conducting goals of care conversations with high-risk Veterans, documenting their goals of care and LST decisions in a standardized, durable LST template that generated LST orders, and honoring the Veteran's decisions for life-sustaining treatments.
Videos
Above:
Leading the Way on the Life-Sustaining Treatment Decisions Initiative
Links
- Establishes processes for initiating goals of care conversations and documentation requirements Life-Sustaining Treatment Handbook
- Resources to support LST implementation including goals of care conversation training Goals of Care Conversation Resources
The results
As of October 7, 2021, there have been nearly 700,000 total goals of care conversations documented on the standardized, accessible LST progress note template. A retrospective observational study of clinical and administrative data from the first 7 months of implementation identified the following as predictors of LST documentation: VA nursing home residence,
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As of October 7, 2021, there have been nearly 700,000 total goals of care conversations documented on the standardized, accessible LST progress note template. A retrospective observational study of clinical and administrative data from the first 7 months of implementation identified the following as predictors of LST documentation: VA nursing home residence, older age, frailty, and comorbidity.
Additional analyses were conducted to examine the association between comfort care goals and care near the end of life for Veteran decedents after implementation of the LSTDI. Sixty-four percent of the Veterans had comfort-care goals with 80% receiving hospice care compared to 57% of Veterans without comfort-care goals. Comfort care documented on the LST template prior to death was associated with significantly lower odds of hospital, ICU and ED use near the end of life. See more
Additional analyses were conducted to examine the association between comfort care goals and care near the end of life for Veteran decedents after implementation of the LSTDI. Sixty-four percent of the Veterans had comfort-care goals with 80% receiving hospice care compared to 57% of Veterans without comfort-care goals. Comfort care documented on the LST template prior to death was associated with significantly lower odds of hospital, ICU and ED use near the end of life. See more
Files
- Publication which evaluates the first 7 months of the implementation of the LSTDI Life-Sustaining Treatment Decisions Initiative: Early Implementation Results of a National Veterans Affairs Program to Honor Veterans’ Care Preferences
- Publication comparing associations of end of life care ratings on the Bereaved Family Survey and LST template documentation Family members' experience improves with care preference documentation in home based primary care
- Publication examining the association between comfort care goals and care near the end of life for Veteran decedents cared for after the VHA introduction of the LSTDI Honoring Veterans’ Preferences: The Association between Comfort Care Goals and Care Received at the End of Life
- Publication describing barriers and facilitators to LSTDI implementation Implementation of VA’s Life-Sustaining Treatment Decisions Initiative: Facilitators and Barriers to Early Implementation Across Seven VA Medical Centers
- Publication describing the pilot of the LSTDI Pilot of the Life-Sustaining Treatment Decisions Initiative Among Veterans With Serious Illness
- Publication describing LSTDI implementation experience Implementing Goals-of-Care Conversations: Lessons From High- and Low-Performing Sites From a VA National Initiative
Metrics
- Number of completed LST templates; % of seriously ill (e.g., CAN score 95 and above) patients with existing LST plan
- Goal concordant care at end of life
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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PROCESSES |
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Optional Resources
Links
- LSTDI Implementation Guide, TMS trainings, worksheets, and other resources/tools. LSTDI Resources
Contact
Comment
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Some of the links on this page are broken for example to LSTDI resources.