Optimizing Transitions for Dual-Use Veterans Living with Dementia followingHospitalization in the Community

背景：退伍军人健康管理局（VA）授权扩大社区护理服务， 退伍军人维护系统和加强综合外部网络（使命）法案 2018.因此，退伍军人事务部越来越多地与社区设施合作， 患有痴呆症的退伍军人（VLWD）将获得社区和VA护理（双重用户）。但有 双重用途退伍军人护理方面的差距，包括住院治疗和分散护理的增加。 意义/影响： 了解社区护理的双重用途退伍军人的健康结果，护理质量， 安全是至关重要的，并提供了使命法的客观措施。我的CDA很重要，因为它有潜力 揭示当前的过渡性护理差距，同时制定一项适应性强、务实的干预措施， VLWD的不良后果。 创新： 我的CDA使用混合方法来识别不良过渡结局， 超长寿命妇女问题和试点干预措施的调整。 VA正在经历一个重大的转变，由于 使命法案。我的CDA研究在评估VLWD的社区护理方面具有创新性，是第一个评估 在《使命法案》时代，为VLWD的成果提供信息，并为适应性试点干预提供信息。开发的方法 并应用于本CDA将提供一个路线图，用于评估和比较护理环境中的结果 同时还确定了护理过渡的障碍和促进因素。 具体目标 目标1：了解医疗保健利用模式和两用VLWD的相关结果。 目标2：了解两用VLWD及其护理伙伴的偏好和过渡性护理需求， 临床医生通过定性访谈。 目标3：调整和试点测试以证据为基础的过渡性护理模式，以改善过渡性护理结果 在艾德访视和/或住院治疗后进行VLWD。 这项工作得到了退伍军人事务部的支持 老年病和扩展护理、社区护理和急诊办公室 医学和 符合退伍军人事务部的优先事项--研究重点是影响退伍军人护理的国家立法优先事项， 尤其是《使命法案》。 方法学：我们将使用混合方法序贯定量到定性设计。首先我们要表演 对两用VLWD进行定量研究，以了解导致不良结局的因素（30天再访）， 住院、30天艾德再入院和出院后30天内的死亡率）。二是 对两用VLWD（n = 25）、其家庭护理人员（n = 25）和临床医生（n = 25)确定过渡期护理的优先事项和需求。第三，我们将利用目标1和2的结果， 试行干预措施，旨在减少极低出生体重的不良后果。使用混合方法，我们将测试 干预的可行性和可接受性。 下一步：CDA的调查结果将成为未来研究有效性和影响的基础 退伍军人的成果。

Background: The Veterans Health Administration (VA) mandated expanded community care services for Veterans with the VA Maintaining Systems & Strengthening Integrated outside Networks (MISSION) Act of 2018. As a result, the VA has increasingly partnered with community-based facilities and growing number of Veterans Living with Dementia (VLWD) will receive community and VA care (dual-users). However, there are gaps in care for dual-use Veterans, including increased hospitalization and fragmented care. Significance/Impact: Understanding community care for dual-use Veteran health outcomes, care quality, and safety is crucial and provides objective measures of MISSION Act. My CDA is significant for its potential to uncover current transitional care gaps, while creating an adaptable, pragmatic intervention aimed at reducing adverse outcomes for VLWD. Innovation: My CDA uses mixed methods to inform the identification of adverse transitional outcomes among VLWD and the adaptation of a pilot intervention. The VA is undergoing a major transformation due to the MISSION Act. My CDA research is innovative in assessing community care for VLWD, is the first to assess outcomes for VLWD in the MISSION Act era and inform adapted pilot intervention. The methods developed and applied in this CDA will provide a roadmap for evaluating and comparing outcomes across care settings while also identifying barriers and facilitators to transitions in care. Specific Aims Aim 1: Understand health care utilization patterns and associated outcomes of dual-use VLWD. Aim 2: Understand preferences and transitional care needs of dual-use VLWD, their care partners, and clinicians through qualitative interviews. Aim 3: Adapt and pilot test an evidence-based transitional care model to improve transitional care outcomes for VLWD following ED visit and/or hospitalization. This work has the support of the VA offices of Geriatrics and Extended Care, community care and emergency medicine and aligns with VA priority-- research focused on national legislative priorities affecting Veteran care, notably the MISSION Act. Methodology: We will use a mixed methods sequential quantitative-to-qualitative design. First, we will perform a quantitative study of dual-use VLWD to understand factors that contribute to adverse outcomes (30-day re- hospitalizations, 30-day ED readmissions and mortality within 30 days of hospital discharge). Second, we will perform a qualitative study of dual-use VLWD (n = 25), their family caregivers (n = 25) and their clinicians (n = 25) to identify transitional care priorities and needs. Third, we will use findings from Aims 1 and 2 to adapt and pilot an intervention aimed at reducing adverse outcomes of VLWD. Using mixed-methods, we will test the feasibility and acceptability of the intervention. Next steps: This CDA findings will be the basis for future work to study the effectiveness and impact on Veteran outcomes.