Evaluating Cash Benefit Programs for Veterans' Long Term Care

这是一份为Kali托马斯博士申请的HSR&D职业发展奖（CDA）， 普罗维登斯VA长期服务和支持创新中心（LTSS）的健康科学家 医学中心托马斯博士的长期职业目标是进行严格的研究，为政策和 旨在推进VA的家庭和社区为基础的服务提供的做法，从而改善 需要LTSS的退伍军人的生活质量和健康结果。预计VA内部对LTSS的需求将 随着退伍军人人口的老龄化继续急剧增长。本CDA将侧重于了解以下方面的作用： 参与者导向（PD）现金福利计划提供的VA，以满足日益增长的需求LTSS。退伍军人事务部， 通过其退伍军人健康管理局（VHA）和退伍军人福利管理局（VBA），提供单独的 和不同的PD现金福利计划的LTSS。VHA的退伍军人指导的家庭和社区为基础的 服务计划（VD-HCBS）根据退伍军人的残疾程度为他们提供每月预算 使他们有机会购买最符合其需要的商品和服务。该公司提供两个 提高每月福利残疾和无家可归的退伍军人接受养老金或补偿：援助 和出勤率（A&A）和家庭福利。在非VA人群中，类似的计划已经成本- 有效和改善参与者的成果。然而，在弗吉尼亚州，关于有效性和获得 这些计划是有限的：仍然很少或根本不了解谁收到这些PD现金福利， 退伍军人如何利用这些福利，他们对福利的满意度，他们的医疗消费， 机构护理，也不是与接受这些现金福利有关的结果。因此， 本申请旨在为VA的PD现金福利计划的研究奠定基础， 制定干预措施，以改善获得这些福利的机会，促进全国对 退伍军人的经验与这些好处，并设置了阶段的研究生涯评估和改进 向退伍军人提供LTSS。该CDA将为托马斯博士提供必要的支持， 以下目标：（1）成为进行严格，实用程序评估的专家， 实施研究;（2）实现比较有效性研究的熟练程度，原始数据 收集和定性研究方法（3）熟悉在VAMC提供LTSS， (4)实现研究独立。这些目标将通过培训和应用来实现， 她在这个奖项中提出的方法形成性研究。具体而言，她的研究旨在（1）使用 行政数据，以确定哪些合格的退伍军人正在服务的医疗中心登记在VA的 PD现金福利计划，（2）探讨VD-HCBS，A&A和Housebound入学率变化的原因 VAMC人员访谈的跨VAMC的好处（3）与退伍军人进行访谈，以描述 他们的经验与退伍军人管理局的PD现金福利计划和（4）建立有效的退伍军人管理局的PD 现金福利计划在控制医疗费用，通过使用先进的方法，比较 退伍军人的医疗保健利用率与接受传统LTSS的退伍军人的医疗保健利用率相比。这项研究意义重大 因为它将提供一个关键的理解谁接受VA现金福利PD护理，原因 变化，退伍军人对PD计划的看法，以及对其结果的了解。的经验和技能 通过综合培训和研究计划获得的知识将加速托马斯博士长期的 长期研究目标，并将为实施创新解决方案，以增加获得现金的机会奠定基础 福利和获得退伍军人的经验与这些福利的国家图片，将在未来提出 优异奖申请。托马斯博士目前和未来的研究将评估方案和实施 创新的解决方案，整合VHA和ESTA，创建一个“一个VA”系统，使老年人，弱势群体， 退伍军人在他们选择的环境中获得适当的，以退伍军人为中心的，具有成本效益的LTSS。

This is an application for an HSR&D Career Development Award (CDA) for Dr. Kali Thomas, a Research Health Scientist in the Center of Innovation for Long-Term Services and Supports (LTSS) at the Providence VA Medical Center. Dr. Thomas' long-term career goal is to conduct rigorous research that will inform policies and practices aimed at advancing the VA's home and community-based service delivery, thereby improving the quality of life and health outcomes of Veterans needing LTSS. The demand for LTSS within VA is expected to continue to grow dramatically as the Veteran population ages. This CDA will focus on understanding the role of participant-directed (PD) cash benefit programs provided by VA to meet the growing need for LTSS. The VA, through its Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA), offers separate and distinct PD cash benefit programs for LTSS. The VHA's Veteran-Directed Home and Community Based Services program (VD-HCBS) provides Veterans with a monthly budget based on the extent of their disability giving them the opportunity to purchase goods and services that best meet their needs. The VBA offers two enhanced monthly benefits to disabled and homebound Veterans receiving pension or compensation: the Aid and Attendance (A&A) and Housebound benefits. In non-VA populations, similar programs have been cost- effective and improved participants' outcomes. However, in VA, information about effectiveness and access to these programs is limited: there remains little to no understanding of who receives these PD cash benefits, how Veterans are utilizing these benefits, their satisfaction with the benefits, their consumption of medical and institutional care, nor the outcomes associated with receiving these cash benefits. Therefore, the objective of this application is to establish a foundation of research about the VA's PD cash benefit programs in order to develop interventions aimed at improving access to these benefits, promote a national understanding of Veterans' experiences with these benefits, and set the stage for a research career evaluating and improving the delivery of LTSS to Veterans. This CDA will provide Dr. Thomas with the support necessary to accomplish the following goals: (1) to become an expert in conducting rigorous, practical program evaluation and implementation research; (2) to achieve proficiency in comparative effectiveness research, primary data collection, and qualitative research methodologies (3) to become familiar with delivery of LTSS at VAMCs and (4) to reach research independence. These goals will be achieved through the training and applied, mixed methods formative research she has proposed in this award. Specifically, her research seeks to (1) use administrative data to determine which eligible Veterans being served by which Medical Centers enroll in VA's PD cash benefit programs, (2) explore reasons for variation in enrollment in VD-HCBS, A&A and Housebound benefits across VAMCs with interviews of VAMC personnel (3) conduct interviews with Veterans to describe their experiences with the VA's PD cash benefit programs and (4) establish the effectiveness of the VA's PD cash benefit programs in controlling healthcare costs by using sophisticated methodologies to compare Veterans' healthcare utilization to that of Veterans receiving traditional LTSS. This research is significant because it will provide a critical understanding of who receives VA cash benefits for PD care, causes for variation, Veterans' perceptions of PD programs, and knowledge of their outcomes. The experience and skills gained through the integrated training and research plan will accelerate progress toward Dr. Thomas' long- term research goal and will set the stage for implementing innovative solutions to increase the access to cash benefits and obtaining a national picture of Veterans' experiences with these benefits, to be proposed in future Merit award applications. Dr. Thomas' current and future research will evaluate programs and implement innovative solutions to integrate VHA and VBA, creating a “One VA” system to enable older, vulnerable Veterans to receive appropriate, Veteran-centered, and cost-effective LTSS in the setting of their choice.