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：医疗保险家庭独立(IAH)演示 在家中为虚弱的老年患者提供提供者管理的综合护理和支持性服务 显示出住院率、30天再住院率、急诊科护理和 每位患者平均每年节省3,070美元的成本。这项研究将检验退伍军人事务部的家庭初级保健 (HBPC)计划是IAH的接受者，在符合IAH资格的退伍军人中产生类似的结果 标准(IAH-Q)。HBPC计划的高昂成本限制了HBPC的可用性，目前它提供的服务较少 超过25%的退伍军人符合IAH-Q。该项目将为老年医疗和长期护理办公室提供 (GEC)政策(10P4G)和运营(10NC4)，以及做出明智决策所需的信息 HBPC方案的有效扩展，以及针对将从中受益最大的退伍军人的工具。 项目背景：IAH演示与更好的结果和更低的医疗成本有关 与常规护理相比。虽然退伍军人管理局自20世纪70年代以来一直实施HBPC计划，但它只提供了一小部分服务 符合医疗保险IAH-Q的退伍军人名单。弗吉尼亚州已将HBPC的运营范围从不到一半扩大到 从2000年的设施发展到今天的几乎所有设施。然而，该计划的覆盖范围仍然受到限制，因为 相对较高的前期成本，以及缺乏容易适用的入院标准来确定哪些人将 从该计划中受益。此外，由于目前一半以上的HBPC参与者不符合弗吉尼亚州IAH-Q 需要有关HBPC应考虑哪些退伍军人的信息，以便该计划可用于 这些退伍军人可能会获得最大的临床和经济利益。 项目目标：第一：VA的HBPC，当目标是IAH-Q退伍军人时，是否实现了同样的临床效果 当联邦医疗保险的IAH-Q受益人接受联邦医疗保险HBPC时的结果和成本节约？ 第二：扩展评估方法，以利用医疗保险评估中没有的VA数据，以及 包括其他估计方法，以测试研究结果的稳健性。 三：退伍军人管理局目前为不符合IAH-Q标准的退伍军人提供HBPC。这些措施的效果是什么？ HBPC在这些其他组中吗？是否有非IAH-Q退伍军人群体的HBPC将花费- 有效吗？此外，在IAH-Q退伍军人中，HBPC有效性的变异性是什么？ 四：制定相当于IAH-Q的目标标准，只使用VA数据，而不依赖CMS的数据， 确定参加HBPC的退伍军人，包括使用VA风险衡量标准改进IAH-Q标准，例如 Jen Frailty Index和CAN得分。 五个： CMS示范项目只考虑了医疗保险支出。HBPC护理如何影响 医疗保险、医疗补助和退伍军人管理局的利用率和成本？ 项目方法：该项目将使用Medicare、Medicaid和VA数据来获取所有相关的利用率和 诊断。我们将确定所有可能在2011年有资格参加HBPC的退伍军人。干预队列 将是所有在2012年接受HBPC的退伍军人。控制组将从那些潜在的 2012年未使用HBPC的符合条件的退伍军人 直接的人口统计匹配，有倾向得分 基于诊断、卫生服务利用、治疗和处方以及MDS或OASIS的匹配 脆弱的评估。我们将跟踪这两个小组到2015年，比较功能状况、利用率和 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.