# Integrating Veteran-Centered Care for Advanced Liver Disease (I-VCALD)

> **NIH VA I01** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2024 · —

## Abstract

Background: Advanced liver disease (AdvLD) is a serious illness that disproportionately affects Veterans. As
many as half of AdvLD patients die within 2 years of developing liver complications, and nearly all suffer
increasing symptoms and hospitalizations. Although many patients hope for curative liver transplantation, few
receive it while experiencing an increasingly severe illness. We found Veterans with AdvLD report many unmet
curative and supportive care needs. They also prefer to align care with their outcome goals earlier in the
AdvLD course than is now common. A Whole Health program in AdvLD focused on what matters most to
Veterans, shared goals, and goal-aligned treatments could improve both curative and supportive care.
Objectives: Our overall goal is to develop and test a sustainable Whole Health, Integrated-Veteran-centered
Care in Advanced Liver Disease (I-VCALD). We propose a hybrid type 1 effectiveness-implementation study
utilizing formative implementation assessment prior to an effectiveness trial and assessment of implementation
outcomes following the trial. Our specific aims are: 1) conduct a formative assessment of I-VCALD
implementation for Veterans with AdvLD; 2) evaluate the effectiveness of I-VCALD in a randomized controlled
study at 4 VA centers; and 3) conduct a summative assessment of implementation outcomes of I-VCALD.
Methods: For Aim 1, we will conduct a formative evaluation of implementation using stakeholder interviews
with patients, leadership, clinicians, and staff partners at the four study sites structured by i-PARiHS
framework. The assessment will identify barriers and promoters of I-VCALD implementation within VA,
strategies to overcome barriers and build on strengths, and modify existing tools to embed them into clinical
structures and workflows. Expected outcomes include recruitment of clinical champions and refinements to
study procedures to facilitate implementation in routine care; care counselor training program; informational
materials; EHR note templates; and menu of communication processes. For Aim 2, we will conduct a
randomized clinical trial to determine if I-VCALD improves timely decisions about transplantation and goals of
care planning. Secondary outcomes include goal concordant care, health related quality of life, shared
decision making, satisfaction with treatment experience, and quality of supportive AdvLD care. Participants will
be identified by population screening at participating sites for AdvLD and new onset complications and
confirmed by manual chart review. Consented patients will be randomized to usual care or referral to I-VCALD
nurse care manager who will conduct 4-5 visits over six months. The care counselor will facilitate serious
illness conversations to assess and cultivate patients’ understanding of their illness, identify patient priorities,
and work with patients’ clinicians to help tailor curative and supportive care such that it aligns with patients’
understanding of thei...

## Key facts

- **NIH application ID:** 10538889
- **Project number:** 1I01HX003541-01A1
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** STEVEN M. ASCH
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2023-10-01 → 2027-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10538889

## Citation

> US National Institutes of Health, RePORTER application 10538889, Integrating Veteran-Centered Care for Advanced Liver Disease (I-VCALD) (1I01HX003541-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10538889. Licensed CC0.

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