权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Medical Foster Homes: A Safe, Cost Effective Substitute for Nursing Homes?

医疗寄养之家：安全、经济高效的疗养院替代品？

基本信息

批准号：
8399648
负责人：
Cari Renee Levy
金额：
--
依托单位：
VA EASTERN COLORADO HEALTH CARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8399648
关键词：
Accidents Address Adverse event Antipsychotic Agents Area Caregivers Caring Catchment Area Characteristics Choices and Control Clinical Cognitive Cognitive deficits Communities Data Data Set Databases Diagnostic Enrollment Ensure Environment Foster Home Care Fostering Funding Geriatrics Goals Home Nursing Care Home environment Hospitalization Individual Infection Inpatients Institutes Interview Life Long-Term Care Matched Group Medical Medical center Methods Modeling Normalcy Nurses Nursing Homes Nursing Research Outcome Outpatients Patient Care Persons Phase Physicians Policies Policy Maker Privacy Protocols documentation Qualifying Relative (related person)Research Research Personnel Safety Services Site Site Visit Structure Veterans Visit base care preference care seeking cohort cost cost effective design experience foster home holistic approach improved information gathering innovation medication compliance meetings operation preference programs success

项目摘要

DESCRIPTION (provided by applicant): Project Background: Since the program began in 2008, 1245 Veterans have received care in a MFH. The program has expanded from three sites in 2008 to 32 sites in 2010; 67 total sites are currently in some phase of initiating a program. The overall goals of this study are to inform VA policies pertaining to community based alternatives for LTC by understanding (1) how Veterans decide to receive care in a private home in the community rather than a traditional institutional setting; (2) which program attributes support their decision; (3) whether MFH is a safe alternative to NH placement; and (4) the costs associated with this model of care. Characterizing successful high-enrollment programs will inform changes to the model as it is nationally disseminated Objectives: Aim 1. Describe what leads Veterans to select or reject MFH placement over NH placement with the goal of assisting VHAs efficiently target recruitment into MFH programs by: Sub-Aim 1A. Comparing characteristics of Veterans residing in 3 high-enrollment MFH programs to the demographic, diagnostic, functional and cognitive characteristics of Veterans residing in NHs in the same VAMC catchment area. Sub-Aim 1B. Conducting in-person interviews with Veterans who have either recently enrolled or declined to enroll in one of 3 high-enrollment MFH programs. Sub-Aim 1C. Performing in-depth qualitative examinations of 3 high and 3 low-enrollment MFH programs to understand how MFH program attributes promote or thwart access to MFH enrollment. Aim 2. Assess safety of the MFH program by comparing adverse event rates among MFH enrollees to propensity matched MFH-eligible Veterans residing in NHs. Aim 3. Calculate VA budgetary costs for care, including non-programmatic inpatient and outpatient cost to the VA, of MFH enrollees compared to propensity-matched MFH-eligible Veterans living in NHs, and estimate total costs of MFH compared to non-MFH care. Methods: MFH residents will be compared to Veterans residing in NHs using data from the Minimum Data Set (MDS) in an unadjusted analysis. MDS data are available for NH residents but are not routinely collected for MFH residents. Thus, on-site research nurses will conduct MDS assessments directly for residents at 3 high- enrollment MFH programs to allow for comparisons of the MFH cohort to Veterans residing in NHs at the same VAMC (Sub Aim1A). Additionally, these on-site nurse researchers will interview 30 Veterans who entered and 30 who declined MFH entry within the last 30 days using a semi-structured protocol to understand the basis of their choices and preferences for care (Sub Aim 1B). In order to better understand why MFH programs have flourished in some areas while not in others, a team of qualitative researchers will undertake in-depth interviews with relevant VAMC administrative and clinical program officials during 2-day site visits at 3 high- enrollment and at 3 low-enrollment MFH programs (Sub Aim 1C). To address the issue of the relative safety of the MFH program versus the alternative of care in a NH, we will identify MFH users and compare the rate at which they experience avoidable hospitalizations, ED visits for accidents and exacerbations of medical conditions, infections, medication adherence and incident use of antipsychotics with a propensity matched group of NH residents drawn from similar medical centers that either had not instituted an MFH or had done so very late (Aim 2). Programmatic and non-programmatic costs of care will then be compared among these propensity matched subjects (Aim 3).

描述（由申请人提供）：项目背景：自2008年该计划开始以来，已有1245名退伍军人在MFH接受护理。该方案已从2008年的3个地点扩大到2010年的32个地点;目前共有67个地点处于启动方案的某个阶段。本研究的总体目标是通过了解（1）退伍军人如何决定在社区的私人住宅而不是传统的机构环境中接受护理，为退伍军人管理局关于长期护理的社区替代方案的政策提供信息;（2）哪些计划属性支持他们的决定;（3）MFH是否是NH安置的安全替代方案;以及（4）与这种护理模式相关的成本。描述成功的高入学率计划将告知模型的变化，因为它是全国传播的目标：目标1。描述是什么导致退伍军人选择或拒绝MFH安置在NH安置与协助VHA有效地目标招聘到MFH计划的目标：子目标1A。比较居住在3个高入学率MFH计划的退伍军人的人口统计学特征，诊断，功能和认知特征的退伍军人居住在NHs在同一VAMC集水区。子目标1B。进行面对面的采访与退伍军人谁要么最近注册或拒绝注册在3个高招生MFH计划之一。子目标1C。对3个高入学率和3个低入学率的MFH项目进行深入的定性检查，以了解MFH项目属性如何促进或阻碍MFH入学。目标2.通过比较MFH登记者与居住在NHs的符合MFH资格的退伍军人之间的不良事件发生率，评估MFH计划的安全性。目标3。计算VA预算成本的护理，包括非程序性住院和门诊费用的VA，MFH登记相比，倾向匹配的MFH合格的退伍军人生活在NH，并估计MFH的总成本相比，非MFH护理。方法：将MFH居民与居住在NHS的退伍军人进行比较，使用最小数据集（MDS）的数据进行未调整分析。MDS数据可用于NH居民，但不定期收集MFH居民。因此，现场研究护士将直接对3个高入组MFH项目的住院医师进行MDS评估，以便将MFH队列与居住在同一VAMC的NH的退伍军人进行比较（子目标1A）。此外，这些现场护士研究人员将使用半结构化方案采访30名在过去30天内进入MFH的退伍军人和30名拒绝MFH进入的退伍军人，以了解他们选择和偏好护理的基础（子目标1B）。为了更好地理解为什么MFH项目在某些地区蓬勃发展，而在其他地区则没有，一组定性研究人员将在为期2天的现场访问期间对相关VAMC行政和临床项目官员进行深入访谈，在3个高入学率和3个低入学率的MFH项目（子目标1C）。为了解决MFH计划与NH中替代护理的相对安全性问题，我们将确定MFH使用者，并比较他们经历可避免的住院、艾德就诊和医疗状况恶化、感染、药物治疗依从性和抗精神病药物的意外使用与来自类似医疗中心的NH居民的倾向匹配组，MFH或很晚才这样做（目标2）。然后将在这些倾向匹配的受试者中比较护理的方案和非方案成本（目标3）。