# Evaluation of the National Implementation of the VA Diffusion of Excellence Initiative on Advanced Care Planning with Group Visits

> **NIH VA I50** · CENTRAL ARKANSAS VETERANS HLTHCARE SYS · 2020 · —

## Abstract

Overview: At present, a five-year (FY17-FY21) Office of Rural Health (ORH) Enterprise Wide Collaborative
Rural Access Solution grant is integrating a Gold Status Practice, Advance Care Planning (ACP) via Group
Visits (ACP-GV), into some of the VHA’s rural VA Medical Centers and Community-Based Outpatient Clinics
(CBOCs). As an emerging best practice model for the delivery of ACP discussions to Veterans in a group format,
ACP-GV has garnered acclaim as an ORH “Promising Practice” and a “Pathways to Partnership” program with
great potential to increase access of ACP discussions beyond rural facilities to all VHA facilities and their
CBOCs. In order to determine the most effective and efficient delivery mechanism that can be sustained beyond
ORH-funding, it is essential to rigorously evaluate the current program. In ACP-GV, Veterans, their families,
and trained clinical staff with expertise in ACP meet in a group setting to have discussions about ACP and the
benefits to Veterans and their trusted others of having an Advance Directive (AD) in place. These discussions
can potentially decrease the risk of Veterans receiving care that is different than what they would prefer or
receiving unwanted interventions that could lead to increased suffering and higher health care costs. As the
primary funding partner, ORH has endorsed this Quality Enhancement Research Initiative (QUERI) Partnered
Evaluation Initiative (PEI), which seeks to expand the current ORH-funded evaluation plan to answer key
sustainability questions and to measure the impact of ACP-GV on dimensions of cost and other outcomes.
Objectives: Developed in close collaboration with key partners from the Office of Rural Health, Care
Management and Social Work Services, the developers from the VISN 16 Geriatric Research, Education, and
Clinical Center (GRECC) and ORH project lead, Dr. Kimberly Garner, the objectives of this partnered
evaluation of ACP-GV are to: 1) evaluate the impact of the ACP-GV National Program on the proportion of ACP
discussions in VHA by comparing ACP-GV sites to propensity score matched control sites not implementing
ACP-GV; 2) among ACP-GV sites, document and compare ORH-funded and DEI-unfunded sites on the
effectiveness of implementation strategies (individual and the combinations) used by sites on ACP discussion
and AD completion rates across VHA; 3) determine the budget impact of the ACP-GV National Program; and
4) identify the characteristics of high-performing (e.g., high rates or sustainers) and innovative sites (e.g.,
unique local program design or implementation of ACP) to inform sustainability and further spread.
Methodology: This evaluation will rely on quantitative and qualitative methods to evaluate the impact of a set
of five implementation strategies deployed by the ACP-GV National Program, primarily through using the
Consolidated Framework for Implementation Research (CFIR) in combination with the RE-AIM framework.
The strategies are: (1) provide new fundin...

## Key facts

- **NIH application ID:** 9837385
- **Project number:** 1I50HX002788-01A1
- **Recipient organization:** CENTRAL ARKANSAS VETERANS HLTHCARE SYS
- **Principal Investigator:** MONICA MATTHIEU
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2019-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9837385

## Citation

> US National Institutes of Health, RePORTER application 9837385, Evaluation of the National Implementation of the VA Diffusion of Excellence Initiative on Advanced Care Planning with Group Visits (1I50HX002788-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9837385. Licensed CC0.

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