Post-Acute Home Health Care for Veterans: Examining Payer Source, Quality, and Outcomes

退伍军人急性后家庭医疗保健：检查付款人来源、质量和结果

• 批准号: 10426941
• 负责人: Stefan Gravenstein
• 金额: --
• 依托单位: PROVIDENCE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10426941
• 关键词: Acute; Admission activity; Affect; Americas; Area; Caregivers; Caring; Characteristics; Collaborations; Communities; Complex; Contracts; Data; Development; Discipline of Nursing; Effectiveness; Enrollment; Foundations; Funding; Geriatrics; Goals; Growth; Health; Health Personnel; Health Policy; Healthcare; Home; Home Care Services; Home Health Agency; Home Health Care Agencies; Hospitalization; Hospitals; Human Resources; Independent Living; Interview; Knowledge; Leadership; Long-Term Care; Measures; Mediating; Medical center; Medicare; Methodology; Methods; Mission; Modeling; Nursing Homes; Outcome; Pathway interactions; Pattern; Personal Satisfaction; Policies; Process; Provider; Qualitative Research; Quality of Care; Recommendation; Research; Research Design; Research Methodology; Resources; Risk; Services; Shapes; Site Visit; Social Work; Source; Structure; Techniques; Testing; Veterans; Work; adverse outcome; care coordination; care outcomes; care systems; cost; experience; health care cost/financing; health care referral; health care service; health care service utilization; high risk; high risk population; hospital readmission; improved; improved functioning; innovation; insight; mortality; patient home care; patient population; primary outcome; provider networks; readmission rates; service delivery; shared decision making; stakeholder perspectives; tool

PROJECT SUMMARY/ABSTRACT Background. Veterans are at increased risk of adverse outcomes after hospital discharge, including rehospitalization, nursing home admission, and mortality. Post-acute skilled home health care (HHC) can provide critical support for Veterans following a hospitalization. The services provided through HHC, including nursing and therapies, can help Veterans meet their goals to improve function, well-being, and return to independent living in their homes. For Medicare-eligible Veterans, skilled HHC is provided through 1) VA purchased skilled HHC from a contracted HHC agency or 2) Medicare-funded HHC (i.e., Part A benefit, Medicare Advantage). Preliminary work suggests that the majority (66%) of Veterans discharged home from VA Medical Centers (VAMCs) with skilled HHC receive VA-contracted skilled HHC and the remainder receive Medicare-funded HHC. However, funding for skilled HHC varies substantially across VAMCs, with implications both for HHC service delivery and Veterans’ outcomes. In preliminary work, we found that 30-day readmissions are higher among Veterans who receive VA-financed HHC compared to Medicare-financed HHC, which could be related to HHC agency quality. Significance/Impact. A better understanding of HHC referrals and financing, which has always been purchased and delivered by community HHC agencies, could provide key insights for the VA given the growth in community care for Veterans. Because community home health agencies have always provided post-acute HHC, this context provides an ideal opportunity to examine interorganizational partnerships and Veterans’ outcomes. The proposed research will characterize post-acute HHC use, financing, and quality of care, and how these factors are associated with outcomes for Veterans discharged from VAMCs, as well as providers’ and Veterans’ experiences of delivering and receiving post-acute HHC. Findings will inform the development of a toolkit for VA and HHC leaders with resources to guide high-value HHC agency selection and collaboration. The contribution of this research is significant because the results will directly inform how operational partners choose HHC agencies to include in provider networks and develop policy for skilled HHC referrals, and will also provide practical tools for multiple stakeholders to provide optimal HHC for Veterans. Innovation. This is the first comprehensive study to examine VA contracting, referral practices, and financing - including both VA and Medicare - to understand their influence on Veterans’ outcomes. A stakeholder- engaged, complex mixed-methods study design is used to understand the mechanisms and processes that shape the use and outcomes of post-acute HHC from multiple perspectives. Specific Aims. 1) Identify determinants of VA vs Medicare-financed post-acute skilled HHC among community dwelling Medicare-enrolled Veterans; 2) Understand multiple stakeholders’ perspectives on older Veterans’ use of post-acute skilled HHC and factors that influence the delivery of HHC; 3) Determine the impact of home health agency quality and HHC payer source on differences in outcomes for older Veterans receiving post- acute HHC. Methodology. This proposal uses a complex mixed-methods study design with advanced statistical techniques and comprehensive VA and Medicare administrative data, as well as a robust qualitative approach to interview stakeholders from VAMCs, HHC agencies, Veterans, and caregivers to accomplish our aims. Implementation/Next Steps. The culmination of findings from this work will be incorporated into a toolkit to promote high-value HHC selection and collaboration. In addition, this work will form the foundation for a large- scale study to develop and test implementation and effectiveness of a shared decision-making model for Veterans and VAMC personnel to promote high-value HHC.

项目总结/摘要 背景退伍军人出院后不良后果的风险增加，包括 再住院、入住疗养院和死亡率。急性期后熟练家庭保健（HHC）可以 为住院后的退伍军人提供关键支持。通过HHC提供的服务，包括 护理和治疗，可以帮助退伍军人实现他们的目标，以改善功能，福祉，并返回 独立生活在家中。对于符合Medicare资格的退伍军人，通过1）VA提供熟练的HHC 从合同HHC机构购买熟练HHC或2）Medicare资助的HHC（即，A部分福利， Medicare Advantage）。初步工作表明，大多数（66%）退伍军人出院回家， 拥有熟练HHC的VA医疗中心（VAMC）接受VA签约的熟练HHC，其余则接受 医疗保险资助的HHC然而，对熟练的HHC的资助在VAMC之间差异很大， 无论是HHC服务交付还是退伍军人的成果。在初步工作中，我们发现30天的重新入院 与医疗保险资助的HHC相比，接受VA资助的HHC的退伍军人的比例更高， 与HHC机构质量有关。 意义/影响。更好地了解HHC转介和融资，这一直是 由社区HHC机构购买和交付，可以为VA提供关键见解， 为退伍军人提供社区护理。因为社区家庭卫生机构一直提供急性后 HHC，这种情况下提供了一个理想的机会，检查组织间的伙伴关系和退伍军人的 结果。拟议的研究将描述急性后HHC的使用，融资和护理质量， 这些因素如何与退伍军人从VAMC出院的结果相关，以及提供者的 和退伍军人的经验，提供和接受急性后HHC。调查结果将为发展提供信息， 为VA和HHC领导人提供的工具包，用于指导高价值HHC机构的选择和合作。 这项研究的贡献是重大的，因为其结果将直接告知业务合作伙伴如何 选择HHC机构纳入提供者网络，并制定熟练HHC转介政策，并将 还为多个利益相关者提供实用工具，为退伍军人提供最佳的HHC。 创新这是第一个全面的研究，以审查VA合同，转介的做法，和融资- 包括退伍军人事务部和医疗保险-了解他们对退伍军人的结果的影响。一个利益相关者- 参与，复杂的混合方法研究设计用于了解机制和过程， 从多个角度塑造急性后HHC的使用和结果。 具体目标。1)确定社区中VA与医疗保险资助的急性期后熟练HHC的决定因素 居住在医疗保险登记的退伍军人; 2）了解多个利益相关者对老年退伍军人的观点 急性期后熟练HHC的使用和影响HHC提供的因素; 3）确定家庭的影响 卫生机构质量和HHC付款人来源对老年退伍军人接受后 急性HHC。 方法论该提案使用复杂的混合方法研究设计， 技术和全面的VA和医疗保险管理数据，以及强大的定性方法 采访来自VAMC，HHC机构，退伍军人和护理人员的利益相关者，以实现我们的目标。 执行/后续步骤。这项工作的成果将纳入一个工具包， 促进高价值HHC的选择和合作。此外，这项工作将形成一个大的基础- 规模研究，以制定和测试共同决策模式的实施和有效性， 退伍军人和VAMC人员，以促进高价值的HHC。