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

通过及时从 VA CLC 退役，增加退伍军人对基于社区的 LTC 的使用

• 批准号: 8398620
• 负责人: SUSAN M ALLEN
• 金额: --
• 依托单位: PROVIDENCE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-01 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8398620
• 关键词: Accident and Emergency department; Acute; Admission activity; Adoption; Area; Back; Budgets; Caring; Case Mixes; Characteristics; Communities; Data Collection; Dependency; Discipline of Nursing; Elderly; Ensure; Goals; Growth; Home environment; Hospitalization; Incentives; Individual; Institution; Institutionalization; Investments; Joints; Leadership; Length; Length of Stay; Long-Term Care; Marketing; Mission; Modeling; Nursing Homes; Policies; Protocols documentation; Qualitative Methods; Quality of life; Rehabilitation therapy; Services; Site; Site Visit; Sorting - Cell Movement; Staff Attitudes; Structure; System; Time; Variant; Veterans; base; community based service; community living; community setting; cost; holistic approach; home based service; innovation; meetings; operation; preference; residence; skills

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.

描述（由申请人提供）： 1999年的《千年法案》促使VA覆盖的长期护理服务的提供发生了变化;具体而言，将长期护理的地点从机构转移到社区。从那时起， 弗吉尼亚州两性平等理事会实施了创新的家庭护理模式，提供家庭服务，推迟或完全避免机构化（Edes，2010年）。然而，我对VA疗养院的重点从主要长期停留机构向短期（急性后）停留社区生活中心（CLC）转移的状况或后果知之甚少，其中退伍军人在家庭环境中接受恢复和康复护理，不鼓励依赖，并在达到治疗目标时迅速返回社区。该项目的总体目标是评估最近（2006年）GEC倡议的影响，以减少CLC停留时间，特别是对排序停留（急性后）退伍军人，包括文化 改造CLC和授权，以加强出院规划，CLC停留时间（LOS）和社区出院成功率的变化，即，无需再入院CLC或非VA疗养院，以及VA和非VA成本。由HATCh通知（转型变革的整体方法）模型，说明了以退伍军人为中心的护理的相互关联的个人，组织和社区组成部分，该项目将使用定量和定性方法来实现以下目标：目标1：a）描述CLC服务水平和成功向社区排放的比率随时间的变化（2004-2013年），并因设施而异，并检查LOS和成功出院（出院无再入院）之间的相互关系。B）在双变量分析中，检查CLC特征与CLC市场中VA和非VA HCBS的投资对CLC LOS和成功出院率变化的关系。 目标二：对CLC市场中CLC特性和HCBS可用性对LOS和成功排放的联合分布的影响进行分析，控制病例组合。 目标三：评估VA和非VA HCBS增长的影响，以及治疗人员和工作人员技能组合的增加，对CLC急性后住院时间的影响，以及对2004-2013年退伍军人成功出院到社区的比率的影响。 目标4：根据先前目标的结果，对加速急性期后护理出院进行预算影响分析。目标5：对8个CLC进行现场访问，根据我们的定量分析进行现场选择，以确定住院时间和成功出院率不同的CLC，以探索可能与CLC变化相关的其他不可测量因素，这些因素最好通过定性数据收集获得，例如，机构和工作人员的态度和价值观，以及入院协议，出院计划，并在出院时向退伍军人提供过渡援助。GEC领导层将利用本研究的结果来完善有关全国CLC使命和运营的现行政策，以确保它们与GEC目标保持一致。此外，传播关于入院、出院和过渡到社区的“最佳实践”管理协议将促进VA CLC文化的转变，并使其使命更接近于使用CLC作为通往限制较少的护理环境的桥梁的理想， 退伍军人的最大自主权，功能和生活质量。