Helping VA optimize its long-term care services

帮助 VA 优化其长期护理服务

• 批准号: 10450638
• 负责人: JOSEPHINE JACOBS
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10450638
• 关键词: Address; Adult; Affect; Ambulatory Care; Area; Budgets; Caregiver support; Caregivers; Caring; Characteristics; Collaborations; Computerized Medical Record; Contract Services; Contractor; Contracts; Data Sources; Databases; Discipline of Nursing; Econometric Models; Effectiveness; Evaluation; Expenditure; Family; Funding; Geriatrics; Goals; Growth; Health; Health Benefit; Health Personnel; Health Services; Health system; Healthcare; Healthcare Market; Home; Home Care Services; Home Health Agency; Individual; Institutionalization; International; Investments; Knowledge; Lead; Level of Evidence; Life; Literature; Long-Term Care; Measures; Medicaid; Mentors; Mentorship; Methods; Modeling; Natural Language Processing; Nursing Homes; Outcome; Patients; Pattern; Performance; Play; Policy Maker; Preparation; Primary Health Care; Research; Research Personnel; Risk; Risk Adjustment; Role; Self Care; Services; Structure; System; Testing; Text; Time; Training; Veterans; acute care; base; care costs; care systems; career development; caregiving; causal model; community based service; community setting; connected care; cost; evidence base; feasibility testing; functional status; health care quality; health care service utilization; high risk; home based service; human old age (65+); improved; informal care; informal caregiver; informal support; innovation; meetings; operation; predictive modeling; programs; prospective; skills; statistics; structured data; success; tool

By 2023, it is expected that the number of VHA enrollees aged 65 and over will increase from 4.1 million to 4.7 million. To meet the growing demand for long-term care services, VA has attempted to expand its home and community-based services (HCBS) through measures such as the 1999 Millennium Health Care and Benefits Act (the Millennium Act). These expansion efforts were based on the premise that HCBS provide care in Veterans’ setting of choice for a lower cost than in institutional settings and with comparable outcomes. Since passing the Millennium Act, however, VA still lags significantly behind other health systems with respect to rebalancing its long-term care expenditures away from institutional care and towards HCBS. VA’s 21 percentage point increase in the proportion of its long-term care expenditures spent on HCBS between 1999 and 2016 (from 5% to 26%) can be compared to Medicaid’s 42 percentage point increase over the same period (from 15% o 57%). VA needs to examine the empirical evidence to understand why this transformation remains elusive. A health system’s ability to rebalance towards HCBS is determined by a combination of patient, system, and family level factors. Precise patient targeting, local home health market conditions, and adequate supply of and support for informal caregivers all contribute to how successful health systems will be in rebalancing towards HCBS. However, these factors remain under-explored in the VA context – in part due to gaps in VA’s structured data and in part due to the limited application of methods that enable these types of analyses. My long-term goal is to become an independent investigator focused on leading research initiatives that help VA to achieve its long-term care rebalancing aims and to fill these gaps in the existing evidence base. The proposed research will strengthen VA’s knowledge of how patient, system, and family level factors are affecting its rebalancing efforts. Specifically, the research aims of this CDA-2 are to: 1) use natural language processing to extract patient functional status from free-text notes and use the constructed measures to improve prediction of Veterans’ one-year risk of institutionalization; 2) build a geospatial database of VA and VA-contracted home health providers and conduct analyses evaluating the association between distance to and market supply of home health agencies and long-term care utilization patterns; and 3) quantify the impact of informal care receipt on VA health care utilization and costs. I will achieve these aims by receiving mentorship and training in natural language processing, risk adjustment, geospatial econometrics, and causal modeling. These new skills will contribute to my overall career development and, in collaboration with my mentors and operational partners, enable me to submit two merit review proposals focused on developing enhanced HCBS patient targeting tools and improved caregivers supports. They will also enable me to submit an application for a partnered evaluation initiative with the Office of Connected Care aimed at developing a geospatial tool to help regional offices efficiently identify prospective partners for new home health service contracts. Overall, this CDA will help me to become an independent investigator focused on leading research initiatives that help VA achieve its long-term care rebalancing aims. The results of this CDA project will be relevant to Veterans, their caregivers, and VA policy makers involved in allocating long-term care funding and will be an innovative contribution to the broader literature on the determinants of successful HCBS expansion strategies.

到2023年，预计65岁及以上的VHA注册人数将从410万增加到470万。 万为了满足对长期护理服务不断增长的需求，VA试图扩大其家庭和 通过诸如1999年千年保健和福利等措施， 千年法案（Millennium Act）。这些扩展工作的前提是，HCBS提供护理， 退伍军人的选择设置为一个较低的成本比机构设置和可比的结果。以来 然而，尽管通过了《千年法案》，弗吉尼亚州在以下方面仍然远远落后于其他卫生系统： 重新平衡其长期护理支出，从机构护理转向HCBS。VA 21 1999年至2000年期间， 2016年（从5%到26%）可以与医疗补助同期42个百分点的增长相比 (from 15%至57%）。VA需要检查经验证据，以了解为什么这种转变 仍然难以捉摸 卫生系统向HCBS再平衡的能力取决于患者、系统和 家庭层面的因素。精确的患者定位，当地家庭健康市场条件，以及充足的 对非正规护理人员的支持都有助于卫生系统如何成功地重新平衡， HCBS。然而，这些因素在VA背景下仍然没有得到充分的探讨-部分原因是VA的差距， 结构化数据，部分原因是有限的应用程序的方法，使这些类型的分析。我 长期目标是成为一名独立的调查员，专注于领导研究计划，帮助VA 实现其长期护理再平衡目标，并填补现有证据基础中的这些空白。 拟议的研究将加强VA的知识，病人，系统和家庭层面的因素是如何 影响其再平衡努力。具体而言，本CDA-2的研究目标是：1）使用自然语言 处理以从自由文本笔记中提取患者功能状态，并使用所构造的测量来 改善对退伍军人一年收容风险预测; 2）建立退伍军人地理空间数据库， VA签约的家庭健康提供者，并进行分析，评估距离和 家庭健康机构的市场供应和长期护理利用模式;以及3）量化 关于退伍军人事务部保健利用和费用的非正式保健收据。我将通过接受指导来实现这些目标 以及自然语言处理、风险调整、地理空间计量经济学和因果建模方面的培训。 这些新技能将有助于我的整体职业发展，并与我的导师和 业务合作伙伴，使我能够提交两份重点放在开发增强型HCBS的优点审查提案 患者定位工具和改进的护理人员支持。他们也将使我能够提交申请， 与互联护理办公室合作开展的评估举措，旨在开发一种地理空间工具， 区域办事处有效地为新的家庭保健服务合同确定可能的合作伙伴。 总的来说，这个CDA将帮助我成为一个独立的调查员，专注于领先的研究计划 这有助于实现其长期护理再平衡目标。该CDA项目的结果将与 退伍军人，他们的照顾者，以及参与分配长期护理资金的退伍军人事务部政策制定者，将是一个 创新性的贡献，更广泛的文献成功的HCBS扩张战略的决定因素。