Whole Health, Age Friendly, and Life Sustaining Treatments
PPC is considered a Whole Health Practice and a model of care supporting Age-Friendly Systems of Care. PPC is the preferred method for asking and acting on ‘What Matters’ for medically complex older adults and should guide care delivery within the other 3M’s. PPC implementation can be counted towards Whole Health and Age-Friendly activities and practices, helping a clinic and facility capture Whole Health and Age-Friendly participation. All three programs strive to identify and align care to ‘What Matters’ to Veterans.
- Webinar: “Using PPC to Identify What Matters to the Veteran,” given by Dr. Ritchey
- Info Sheet: Intersection between Whole Health, Age-Friendly, and PPC
- Contact: Find local Whole Health Facility contacts
Engagement with local or facility level Whole Health Partners is a good strategy with implementation of PPC and Age Friendly Systems of Care. Both the PPC approach and tools such as the Patient Health Inventory (PHI) can help elicit ‘what matters’ to a veteran. PPC however is an approach that was specifically designed with complex, older veterans in mind and its training is unique and different from Whole Health coaching.
Clinicians who have undergone Whole Health training are well-suited to PPC. Prior Whole health training is not mandatory but extremely helpful and may quicken the proficiency to become a clinician who practices the PPC approach. We encourage you to reach out to your local/facility Whole Health Partners (i.e., director, coaches, staff) to collaborate on ways PPC and Age-Friendly Systems of Care can extend Whole Health clinical care and well-being programs to older, complex Veterans.
Health Factors for Age-Friendly and PPC are Whole Health Health Factors, and thus capture the delivery of Whole Health and Age-Friendly Clinical Work Load. There may be other ways to code for Whole Health when integrating PPC into your clinical care.
To gain access to the VA Age-Friendy Dashboard, contact agefriendly@va.gov. Note: This dashboard is for internal VA use only.
PPC conversations and/or notes (templates) do not replace a LST note. Patient Priorities Care is about co-current care planning, thus a separate entity in the larger picture of advanced care planning. PPC facilitate conversations about what is happening now in the context of a person with multiple complex, chronic health conditions who may have a shorter life expectancy but are not technically at the end of their life. The identification of patient values and priorities through the PPC approach is a helpful companion to more specific conversations about end-of-life decisions and resuscitation preferences. However, you should continue to document patient preferences related to serious/terminal illness and life sustaining treatments (i.e., DNAR orders) using the LST note template.
Well-Being Signs Tool
The Well-Being Signs tool is a 3-question clinical assessment that was designed to provide a quick snapshot of how patients are doing in their daily lives.
- The Well-Being Signs can jump start discussions of patient well-being and facilitate agenda setting at any given point of care.
- Because the Well-Being Signs use a 0-10 scale, the tool also offers the ability to track scores over time for a given patient.
- Access the Well-Being Signs standardized introductory script, 3-question tool, and optional modifications for use with older adults.
How the Well-Being Signs Tool supports PPC
Using the Well-Being Signs can support the PPC approach when exploring ‘what matters.’
- The Well-Being Signs can be used in partnership with PPC by offering quantitative, standardized questions about well-being that can inform the trajectory of PPC conversations and assist with tracking clinical metrics.
- For example, tracking administration of the Well-Being Signs can support other methods of tracking PPC (such as through PPC Health Factors) for clinical settings seeking a countable metric for the Age-Friendly “What Matters M.”
- Like PPC, Well-Being Signs are included on the VA Age-Friendly Note Template.
- In CPRS, this is found under Shared Templates > “Age Friendly 4Ms”
More information on the Well-Being Signs Tool
The Well-Being Signs tool was developed at the VHA Office of Patient-Centered Care and Cultural Transformation.
- Implementation of the Well-Being Signs has been supported by Whole Health since 2022. Validity testing was performed with a general Veteran population.
- For more Well-Being Signs information and materials, please see this fact sheet and this VA SharePoint (VA internal use only).
- For questions or support with Well-Being Signs implementation, please contact: vhaopcc&ctwellbeingsignsworkgroup@va.gov
- For questions about implementation of the Well-Being Signs in Geriatrics settings, you may contact Eileen.Dryden@va.gov or Catherine.Dawson@va.gov.