Does VA Home-Based Primary Care Reduce Costs Among Veterans Eligible for Independence at Home?

对退伍军人医疗保健的预期影响：医疗保险在家独立（IAH）演示 为体弱长者提供由医护人员管理的家居综合护理及支援服务 显示出住院率、30天再住院率、急诊室护理率和 平均每位患者每年节省3，070美元的费用。这项研究将检查VA的家庭基础初级保健是否 （HBPC）计划，IAH的始作俑者，在符合IAH资格的退伍军人中产生了类似的结果 标准（IAH-Q）。高HBPC计划成本限制了HBPC的可用性，目前服务较少 超过25%的退伍军人符合IAH-Q。该项目将提供老年病和长期护理办公室 (GEC)政策（10 P4 G）和运营（10 NC 4），其中包含做出明智决策所需的信息， HBPC计划的有效扩展，以及针对将从中受益最多的退伍军人的工具。 项目背景：IAH演示与更好的结果和降低的医疗成本相关 与常规护理相比。虽然弗吉尼亚州自20世纪70年代以来一直在实施HBPC计划，但它只提供了一小部分 符合医疗保险IAH-Q的退伍军人。VA已经扩大了HBPC的运营规模， 从2000年的设施到今天的几乎所有设施。然而，该计划的范围仍然受到限制，因为 前期费用相对较大，而且缺乏现成适用的录取标准来确定那些 受益于该计划。此外，由于目前超过一半的HBPC注册者不符合IAH-Q，VA 需要关于哪些退伍军人应该考虑HBPC的信息，以便该计划可以提供给 这些退伍军人谁可能会实现最临床和经济效益。 项目目标：一：VA的HBPC，当针对IAH-Q退伍军人时，是否达到相同的临床效果？ 结果和成本节约作为医疗保险的IAH-Q受益人接受医疗保险HBPC？ 第二：扩展评估方法，以利用医疗保险评估无法获得的VA数据，以及 包括其他估计方法，以测试调查结果的可靠性。 三：VA目前向不符合IAH-Q标准的退伍军人提供HBPC。成效如何 HBPC在这些组中？是否有非IAH-Q退伍军人群体的HBPC将成本- 有效？此外，IAH-Q退伍军人中HBPC有效性的变异性是什么？ 第四：制定与IAH-Q相当的目标标准，仅使用VA数据，而不依赖CMS的数据， 确定HBPC入组的退伍军人，包括使用VA风险指标完善IAH-Q标准，例如 JEN虚弱指数和CAN评分。 第五条： CMS示范项目只考虑医疗保险支出。HBPC护理如何影响 医疗保险、医疗补助和退伍军人事务部的利用率和成本？ 项目方法：本项目将使用Medicare、Medicaid和VA数据来获取所有相关的利用率， 诊断。我们将确定2011年可能有资格获得HBPC的所有退伍军人。干预队列 所有在2012年接受HBPC的退伍军人。对照组将从那些潜在的 2012年未使用HBPC的合格退伍军人， 一个直接的人口统计匹配， 基于诊断、卫生服务利用、治疗和处方以及MDS或OASIS的匹配 脆弱性评估我们将跟踪这两个组直至2015年，比较功能状态、利用率 服务和成本。

Anticipated Impacts on Veteran's Healthcare: The Medicare Independence-at-Home (IAH) demonstration which provides frail elderly patients with provider-managed integrated care and supportive services at home has shown reduced rates of hospitalizations, 30-day rehospitalizations, emergency department care, and an average $3,070 annual costs savings per patient. This study will examine if VA's Home Based Primary Care (HBPC) program, the inceptor of IAH, produces similar outcomes among Veterans who meet IAH qualifying criteria (IAH-Q). High HBPC program costs have limited the availability of HBPC and it is currently serving less than 25% of Veterans who meet IAH-Q. This project will provide the Offices of Geriatrics and Extended Care (GEC) Policy (10P4G) and Operations (10NC4) with information needed to make informed decisions about effective expansion of the HBPC program, and tools to target Veterans who will benefit from it most. Project Background: The IAH demo is associated with better outcomes and reduced healthcare costs compared to routine care. While VA has operated the HBPC program since the 1970s, it only serves a fraction of the Veterans who meet the Medicare IAH-Q. VA has expanded HBPC from operating in less than half its facilities in 2000 to almost all facilities today. However, the program's reach is still constrained because of the relatively large up-front costs and the lack of readily applicable admission criteria to identify those who would benefit from the program. Further, since over half of the current HBPC enrollees do not meet the IAH-Q, VA needs information on which Veterans should be considered for HBPC so that the program can be available to those Veterans who will likely achieve the most clinical and economic benefit. Project Objectives: One: Does VA's HBPC, when targeted to IAH-Q Veterans, achieve the same clinical outcomes and cost savings as Medicare's IAH-Q beneficiaries receiving Medicare HBPC? Two: Extend the evaluation methods to exploit VA data that was not available to the Medicare evaluation, and include alternative estimation methods to test the robustness of the findings. Three: VA currently provides HBPC to Veterans who do not meet IAH-Q criteria. What is the effectiveness of HBPC in these other groups? Are there non-IAH-Q groups of Veterans for whom HBPC would be cost- effective? Further, what is the variability in the effectiveness of HBPC among IAH-Q Veterans? Four: Develop targeting criteria equivalent to IAH-Q that use only VA data, without relying on data from CMS, to identify Veterans for HBPC enrollment, including refinement of IAH-Q criteria with VA risk measures such as JEN Frailty Index and CAN scores. Five: The CMS demonstration project considered only Medicare expenditures. How does HBPC care affect utilization and costs across Medicare, Medicaid and VA? Project Methods: This project will use Medicare, Medicaid and VA data to capture all relevant utilization and diagnoses. We will identify all Veterans who were potentially eligible for HBPC in 2011. The intervention cohort will be all Veterans who received HBPC in 2012. The control group will be determined from those potentially eligible Veterans who did not use HBPC in 2012 using a direct demographic match, with a propensity score matching based on diagnoses, health services utilization, treatments and prescriptions and MDS or OASIS frailty assessments. We will follow both groups through 2015, comparing functional status, utilization of services, and costs.