Increasing Veterans' Use of Community-based LTC via timely Discharge from VA CLCs

描述(由申请人提供)： 1999年的《千年法》促使退伍军人保险覆盖的长期护理的提供方式发生了变化；具体地说，将长期护理的重心从机构转移到了社区。从那时起， Va GEC通过提供延迟或完全避免制度化的基于家庭的服务，实施了基于家庭的护理的创新模式(Edes，2010)。然而，我对退伍军人疗养院将重点从主要长期住宿机构转移到短期(急性后)社区生活中心的状况或后果知之甚少，在短期(急性后)社区生活中心，退伍军人在家庭环境中接受恢复性和康复护理，从而在达到治疗目标时能够迅速返回社区。这个项目的总体目标是评估最近(2006年)GEC倡议减少CLC停留时间的影响，特别是对包括文化在内的分类停留(急性后)退伍军人 转变社区护理中心和任务，以加强出院规划，根据社区护理中心住院时间(LOS)和社区出院成功率的变化，即不重新入院到社区护理中心或非退伍军人管理局，以及退伍军人管理局和非退伍军人管理局的费用。在HATCH(整体转型方法)模型的启发下，该项目将使用定量和定性的方法来实现以下目标：目标1：描述CLC LOS和成功出院到社区的比率随着时间的变化(2004-2013年)和不同设施的变化，并检查LOS和成功出院(不再入院)之间的相互关系。B)在双变量分析中，检验CLC特性与CLC市场上对VA和非VA HCBS的投资对CLC LO和成功率变化的关系。目的2：分析《中图法》的特点和六氯苯在《中图法》市场的可获得性对LOS和成功排放的联合分布的影响，并对病例组合进行控制。目的3：评估2004-2013年间退伍军人和非退伍军人Hcbs的增长，以及治疗人员和工作人员技能组合的增加对CLC急性发作后停留时间和退伍军人成功退伍军人退伍率的影响。目标4：根据先前目标的结果，对加速急诊护理后出院的预算影响进行分析。目的5：对8个社区卫生服务中心进行实地考察，根据我们的定量分析确定不同住院时间和出院成功率的社区卫生服务中心，以探索其他可能与这些因素中的社区卫生服务中心差异有关的未测量因素，并通过收集定性数据获得这些因素，例如，机构和工作人员的态度和价值观，以及为退伍军人提供的入院、出院规划和过渡援助方案。GEC领导层将利用这项研究的结果，在全国范围内完善关于CLC的使命和业务的现行政策，以确保它们与GEC的目标保持一致。此外，向社区传播有关入院、出院和过渡的“最佳做法”管理方案，将推动退伍军人社区卫生服务中心的文化和使命的转变，更接近将社区卫生服务中心作为桥梁，通向限制较少的护理环境的理想，该环境允许 退伍军人的最大自主权、职能和生活质量。

DESCRIPTION (provided by applicant): The Millennium Act of 1999 precipitated change in the delivery of VA-covered long term care (LTC); specifically, to shift the locus of LTC from institutions to the community. Since that time, VA GEC has implemented innovative models of home-based care by providing home-based services that either delay or avoid institutionalization altogether (Edes, 2010). However, little i known about the status or consequences of the shift in emphasis of VA nursing homes from primarily long stay institutions to short (post-acute) stay Community Living Centers (CLCs) in which Veterans receive restorative and rehabilitative care in a home environment that discourages dependency and enables prompt return to the community when treatment goals are met. The overall goal of this project is to evaluate the impact of recent (2006) GEC initiative to reduce length of CLC stays, particularly for sort stay (post-acute) veterans, including Cultural Transformation of CLCs and mandates to enhance discharge planning, on changes in CLC length of stay (LOS) and rates of successful community discharge, i.e., without readmission to CLCs or non-VA nursing homes, and VA and non-VA costs. Informed by the HATCh (Holistic Approach to Transformational Change) model illustrating the interrelated individual, organizational and community components of Veteran- centered care, the project will use quantitative and qualitative methods to accomplish the following aims: Aim 1: a) Describe CLC LOS and rates of successful discharge to the community as they change over time (2004-2013) and vary by facilities, and examine the inter-relationship between LOS and successful discharge (discharge without readmission). b) In bivariate analyses, examine the relationship of CLC characteristics and the investment in VA and non-VA HCBS in the CLC market on the changes in CLC LOS and rates of successful discharge. Aim 2: Conduct an analysis of the impact of CLC characteristics and HCBS availability in the CLC market on the joint distribution of LOS and successful discharges, controlling for case-mix. Aim 3: Evaluate the impact of growth in VA and non-VA HCBS, and increase in therapy staff and staff skill mix, on length of CLC post-acute stays, and on rates of successful discharge of Veterans to the community for the years 2004-2013. Aim 4: Conduct a budget impact analysis of accelerating discharge from post acute care based on the findings from the previous aims. Aim 5: Conduct site visits to 8 CLCs with site selection informed by our quantitative analysis that will identify CLCs with varying lengths of stay and rates of successful discharge in order to explore other unmeasured factors likely to be related to CLC variation in these factors and that are best captured through qualitative data collection, e.g., institutional and staff attitudes and values, and protocols for admission, discharge planning, and transition assistance provided to Veterans at discharge. Results of this study will be used by GEC leadership to refine current policies regarding the mission and operations of CLCs nationally to ensure that they align with GEC goals. Further, dissemination of "best practice" administrative protocols regarding admission, discharge and transitions to the community will advance the transformation of VA CLCs' culture and mission closer to the ideal of using the CLC as a bridge to a less restrictive care setting that allows for Veterans' maximum autonomy, functioning and quality of life.