Evaluation of Veteran-Directed Home and Community Based Services

对退伍军人主导的家庭和社区服务的评估

• 批准号: 9934873
• 负责人: JAMES L RUDOLPH
• 金额: --
• 依托单位: PROVIDENCE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9934873
• 关键词: Biological Models; Caregiver Burden; Caregiver well-being; Caregivers; Caring; Characteristics; Cognitive deficits; Collaborations; Communities; Complex; Data; Effectiveness; Eligibility Determination; Enrollment; Environment; Evaluation; Evidence based program; Financial Hardship; Geriatrics; Health; Health Care Costs; Health Services; Health Status; Home environment; Hour; Interview; Investments; Lead; Light; Long-Term Care; Measures; Medical center; Methods; Modeling; Nature; Outcome; Participant; Personal Satisfaction; Policies; Population; Process; Quality of life; Randomized; Recommendation; Reporting; Research Design; Research Personnel; Resources; Role; Self-Direction; Services; System; Testing; Veterans; Vulnerable Populations; base; care giving burden; caregiving; community based service; community living; contextual factors; cost; cost effective; depressive symptoms; experience; flexibility; health care service; implementation research; implementation strategy; improved; informant; information gathering; meetings; operation; patient home care; person centered; preservation; programs; satisfaction; service delivery; service programs

In the next decade, there will be a doubling of older Veterans for whom the VA has a requirement to provide long-term care. At a cost of $110,000 per year for long-term care, Geriatrics and Extended Care (GEC) is seeking to preserve Veteran independence in the community. VD-HCBS is a person-centered consumer- directed program that provides Veterans the opportunity to self-direct their long-term services and supports (LTSS) and continue to live independently at home. GEC is planning to expand VD-HCBS to an additional 90 VAMCs over the next 3 years and has partnered with the Program Evidenced-based Policy Resource Center (PEPReC) for a randomized, stepped-wedge dissemination and an evaluation of utilization outcomes. This proposal will provide important outcomes and context to the VD-HCBS expansion. The specific aims of this proposal are: Aim 1: To describe the impact of VD-HCBS on Veterans’ satisfaction, unmet need for services, quality of life and independence using mixed methods. Aim 1 will utilize operations data to describe the change in Veteran-reported satisfaction, unmet needs, and independence from enrollment in VD-HCBS to 3 and 12 months. Additionally, we will conduct interviews with Veterans to capture their experiences with the program. Aim 2: To understand the effect of VD-HCBS on Caregivers’ well-being. Aim 2 will compare Caregivers’ financial strain, depressive symptoms, caregiving stress, and health status and positive caregiver experiences to a propensity matched population from existing VA data to determine the impact of the VD-HCBS program on Caregivers. Aim 3: To examine the implementation of the VD-HCBS program expansion. Aim 3 will utilize the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change to interview coordinators, and other key informants, from VA and ADNA VD-HCBS pairs. The analysis will shed light on how contextual factors and implementation strategies relate to implementation and Veteran outcomes. VD-HCBS has tremendous opportunity to improve the fiscal outlook of GEC’s LTSS while delivering the highest level of Veteran-centered care. In concert with the outcomes of VD-HCBS, our implementation evaluation will be critical to determining how the VA system, in partnership with community-based organizations, implements programs and illuminating important leverage points to facilitate implementation effectiveness. With the diverse team assembled and the comprehensive evaluation proposed, we will produce evidence to inform VA program implementation and dissemination, a critical component of the VA’s priorities to develop high-performing, highly-reliable, and consistent networks.

在接下来的十年里，退伍军人事务部需要为老年退伍军人提供双倍的服务