Aligning Post-Acute Care with Veterans Values and Priorities

使急性后护理与退伍军人的价值观和优先事项保持一致

• 批准号: 10425145
• 负责人: Kirstin Anne Manges
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10425145
• 关键词: Address; Aging; Caregiver Burden; Caregivers; Caring; Categories; Climacteric; Clinical; Communities; Complex; Data; Data Set; Decision Making; Development; Disadvantaged; Ensure; Evaluation; Evidence based practice; Face; Family; Foundations; Goals; Home; Home Care Services; Home Health Agency; Home Health Care Agencies; Hospitalization; Hospitals; Individual; Injury; Inpatients; Interview; Knowledge; Lead; Life; Light; Literature; Long-Term Care; Measurable; Measures; Medical Care Team; Medicare; Methodology; Methods; Nursing Homes; Outcome; Patient-Focused Outcomes; Patients; Policies; Policy Maker; Preparation; Provider; Quality of life; Recording of previous events; Recovery; Replacement Arthroplasty; Reporting; Research; Research Personnel; Research Training; Sampling; Science; Services; Skilled Nursing Facilities; Sorting - Cell Movement; Techniques; Testing; Time; Training; Veterans; Work; acute care; base; black patient; care costs; care delivery; care preference; care systems; career; cohort; falls; functional improvement; health goals; high risk; hospital readmission; implementation outcomes; improved; innovation; insight; large datasets; military veteran; mortality; novel; patient oriented; preference; pressure; programs; racial and ethnic disparities; readmission rates; skills; support tools; tool; user centered design; web site

Background Every day, more than 600 hospitalized Veterans face a time-pressured, complex, high-stakes choice regarding post-acute care (PAC) supports following hospitalization. While nearly all efforts to improve PAC choice have focused on which provider to use, the type of PAC services selected can have life-altering implications in terms of patient outcomes, finances, and caregiver burden. For the majority of older Veterans, the main choices are to go to a skilled nursing facility (SNF) or go home, with or without home health care (HH). In preliminary work, we found that Veterans are infrequently included in post-acute care decision-making and are not informed about tradeoffs between PAC settings. Significance/Impact This research program will provide critical knowledge to Veterans, clinicians, and policy makers about Veterans' outcomes across PAC settings, while also piloting a tool to support high-quality decision-making by better aligning Veterans priorities with services. Innovation This theoretically driven mixed methods approach will draw from decision science, use large datasets, and incorporate user-centered design to reveal new insights into what matters most to Veterans discharged to PAC, and how best to align care with their values and goals. Veterans' priorities and goals for PAC are unknown, and our approach will establish important patient-centered outcomes for the VA to consider in achieving patient-centered PAC. I will use these findings to develop a new PAC decision support tool that is feasible and acceptable to patients, caregivers, and clinicians. Specific Aims My specific aims include: 1) Identify attributes of PAC that matter most to a diverse sample of older Veterans and caregivers when making decisions about post-discharge supports. 2) Determine differences in 100-day outcomes for older hospitalized Veterans who receive PAC via SNF vs. HH. 3) Develop and pilot a decision tool to elicit hospitalized Veterans' priorities for PAC, so they may be shared with the healthcare team. Methodology To better inform PAC decisions and evidence-based practice, in Aim 1 I will first use a mixed-methods approach informed by decision-science to identify what matters most to Veterans and caregivers when deciding between care types. In Aim 2, I will compare patient-centered outcomes between PAC settings to identify important trade-offs in SNF vs. HH. I will use advanced statistical techniques and a unique dataset (the 2012-16 Residential History File) to accomplish this aim. Last, in Aim 3 with methods from user centered design, I will rigorously identify what matters most to Veterans when making PAC decisions and pilot a decision tool. Next Steps/Implementation This research program will help better out understand the tradeoffs in outcomes between post-acute care services, while piloting a tool to support decision-making.

背景 每天，600多名住院退伍军人面临着时间紧迫、复杂、事关重大的选择 急性后护理(PAC)支持住院后的护理。虽然几乎所有改善政治行动委员会选择的努力都有 关注于使用哪种提供商，所选的PAC服务类型可能会在以下方面改变生活 病人的结果、经济状况和照顾者的负担。对于大多数年长的退伍军人来说，主要的选择是 去熟练的护理机构(SNF)或回家，无论有没有家庭保健(HH)。在前期工作中， 我们发现，退伍军人很少被包括在急救后的护理决策中，而且不被告知 关于PAC设置之间的权衡。 重要性/影响力 该研究计划将为退伍军人、临床医生和政策制定者提供关于 退伍军人在PAC设置中的结果，同时还通过以下方式试用工具来支持高质量决策 更好地将退伍军人的优先事项与服务相结合。 创新 这种理论驱动的混合方法方法将借鉴决策科学，使用大型数据集，并 融入以用户为中心的设计，以揭示对退伍军人最重要的东西 PAC，以及如何最好地将关怀与他们的价值观和目标相结合。退伍军人政治行动委员会的优先事项和目标是 未知，我们的方法将建立重要的以患者为中心的结果，供退伍军人管理局在 实现以患者为中心的PAC。我将使用这些发现来开发一个新的PAC决策支持工具，该工具是 患者、护理者和临床医生都可以接受。 具体目标 我的具体目标包括：1)确定对不同的老年退伍军人样本最重要的PAC属性 和照顾者在做出关于出院后支持的决定时。2)确定100天内的差异 通过SNF和HH接受PAC治疗的老年住院退伍军人的结局。3)制定和试行决策 这是一种工具，用于得出住院退伍军人对PAC的优先事项，以便与医疗团队共享。 方法论 为了更好地为委员会的决策和循证实践提供信息，在目标1中，我将首先使用混合方法 由决策科学提供信息的方法，以确定在以下情况下对退伍军人和照顾者最重要的事情 在护理类型之间做出选择。在目标2中，我将比较PAC设置和PAC设置之间以患者为中心的结果 确定SNF与HH之间的重要权衡。我将使用先进的统计技术和一个独特的数据集( 2012-16居住历史文件)来实现这一目标。最后，在目标3中，以用户为中心的方法 设计，我将严格确定在做出政治行动委员会决策和试点时对退伍军人最重要的是什么 决策工具。 后续步骤/实施 这项研究计划将有助于更好地理解急性后护理之间的结果权衡 服务，同时试行支持决策的工具。