Evaluation of Veteran-Directed Home and Community Based Services

在接下来的十年里，退伍军人事务部要求提供的老年退伍军人人数将增加一倍。 长期护理。老年病和延续护理（GEC）每年的长期护理费用为11万美元， 在社区中维护退伍军人的独立性。VD-HCBS是一个以人为本的消费者- 定向计划，为退伍军人提供自我指导其长期服务和支持的机会 （LTSS），并继续在家中独立生活。GEC计划将VD-HCBS扩展到另外90个 VAMC在未来3年，并已与基于证据的政策资源中心计划 （PEPReC）进行随机、阶梯楔形分布和使用结果评价。这 该提案将为VD-HCBS的扩展提供重要成果和背景。具体目标是 目标1：描述VD-HCBS对退伍军人满意度的影响，未满足的服务需求， 生活质量和独立性使用混合方法。目标1将利用运营数据来描述变更 在退伍军人报告的满意度，未满足的需求，以及从VD-HCBS招募的独立性方面，分别为3和12 个月此外，我们将与退伍军人进行采访，以捕捉他们的经验与计划。 目的2：了解维生素D-HCBS对照顾者幸福感的影响。目标2将比较护理人员的 财务紧张、抑郁症状、工作压力、健康状况和积极的照顾者体验 从现有VA数据中选择倾向匹配人群，以确定VD-HCBS项目对 照顾者目标3：审查VD-HCBS方案扩展的执行情况。目标3将利用 执行情况研究综合框架和专家建议 从VA和ADNA VD-HCBS对改为采访协调员和其他关键线人。分析 将阐明背景因素和实施策略如何与实施和退伍军人 结果。VD-HCBS有巨大的机会改善GEC的LTSS的财政前景，同时提供 以退伍军人为中心的最高水平的护理。与VD-HCBS的成果相一致，我们的实施 评估将是至关重要的，以确定如何VA系统，在与社区为基础的伙伴关系， 组织，实施计划，并阐明重要的杠杆点，以促进实施 有效性随着多元化的团队聚集和综合评估的提出，我们将产生 为退伍军人事务部计划的实施和传播提供信息的证据，这是退伍军人事务部优先事项的关键组成部分， 开发高性能、高可靠性和一致性的网络。

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.