Home Excellence Research and Outcomes Center to Advance, Redefine and Evaluate Non-institutional Caregiving (HERO CARE)

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The goal of the Home Excellence Resource Center to Advance, Redefine, and Evaluate Non- Institutional Care (HERO CARE) Center of Excellence is to expand the capacity of the VA to deliver integrated, Veteran- and caregiver-partnered, data-driven approaches to non-institutional care across VA. The VA cares for Veterans across a wide range of disabilities and ages whose care requires the involvement of caregivers and use of home- and community-based services. Yet information regarding which Veterans are most likely benefit from which types of care is lacking, current systems of treatment delivery too often fail to meet the needs of Veterans and caregivers, services available are often limited due to local facility resource lack or mismatch, and a comprehensive system for implementing, evaluating, and disseminating best practices through VA operational offices has not been fully developed. Using an adaptation of the chronic care model as our theoretical framework, we propose a set of aims that will enable the VA to provide the most appropriate and effective non-institutional care matched to each Veteran’s needs and circumstances. Our work supports the rapid production of knowledge, using shared metrics and data as a common platform for evaluation and feedback, with the goal of empowering Veterans, caregivers, VA and non-VA providers, and leadership in making informed choices regarding care services and program planning. Our specific aims are as follows: Aim 1: Pilot innovative interventions to improve non-institutional care at each of the four VAMCs involved in this proposal, using a hybrid implementation / effectiveness approach to evaluate feasibility and impact. Our pilots will be conducted by each site in partnership with the Innovation Core, focusing on coordination between Veterans and caregivers, as well as between VA and non-VA care. Aim 2: Develop and validate stakeholder-driven outcome and performance metrics to aid in evaluating home- and community-based care programs and delivery across VA. This aim will be led by the Outcomes and Implementation (O&I) Core. Aim 3: Determine the optimal clusters of non-institutional care delivery elements for different Veteran populations. The Data and Policy (D&P) Core will oversee modeling efforts to determine the most effective non-institutional care elements for different populations. Aim 4: Integrate findings and deliverables from across these aims to develop a toolkit that can be used across VA to improve non-institutional care. Toolkit components will include curricula for training and delivery of best practices in home- and community-based care, a stakeholder-driven set of outcome and performance metrics, a local site needs and readiness assessment tool, and recommendations for implementation of specific programs and program types, and will be packaged for VA-wide dissemination by the O&I Core. Our multi-disciplinary team of clinicians and health services researchers across four VAMCs will work in tandem to ensure the HERO CARE Center of Excellence serves as a model for excellence in training, innovation, evaluation, implementation and spread of best practices in non-institutional care across VA and beyond. The resulting work will enable a cycle of improvement that is vital to the VA transformation to a Learning Health Care System, and that will enable VA to meet the needs of Veterans and caregivers in the decades to come.