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

优化社区住院后患有痴呆症的两用退伍军人的过渡

• 批准号: 10538945
• 负责人: Roman Ayele
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538945
• 关键词: Accident and Emergency department; Address; Adult; Affect; Alzheimer' s Disease; American; Area; Behavior; Benefits and Risks; Caregivers; Caring; Chronic; Communities; Community Healthcare; Community Hospitals; Data; Dementia; Deterioration; Development; Emergency Medicine; Emergency department visit; Environment; Evidence based intervention; Face; Family Caregiver; Funding; Future; Geriatrics; Goals; Health; Health Care Costs; Health Services Accessibility; Healthcare; Home; Homogeneously Staining Region; Hospital Departments; Hospitalization; Hospitals; Impairment; Improve Access; Incidence; Institutionalization; Intention; Intervention; Interview; Investments; Judgment; Knowledge; Language; Length of Stay; Long-Term Care; Measures; Medication Management; Memory; Methodology; Methods; Modeling; Neurodegenerative Disorders; Outcome; Outcome Assessment; Patient Care; Patients; Pattern; Policies; Post-Traumatic Stress Disorders; Prevalence; Quality of Care; Recording of previous events; Research; Research Personnel; Research Priority; Resources; Risk; Risk Factors; Safety; Shapes; System; Testing; Traumatic Brain Injury; Veterans; Veterans Health Administration; Visit; Work; acceptability and feasibility; acute care; adverse outcome; care coordination; care fragmentation; care outcomes; care preference; care systems; career; career development; community based care; community based service; design; effectiveness study; effectiveness testing; evidence base; feasibility testing; health care delivery; health care service utilization; high risk; hospital care; hospital readmission; human old age (65+); implementation science; improved; improved outcome; innovation; mortality; patient oriented; pilot test; poor health outcome; pragmatic intervention; preference; prevent; service delivery; treatment as usual

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.

背景：退伍军人卫生管理局（VA）要求扩大社区护理服务 VA维护系统的退伍军人并加强了综合外部网络（Mission） 2018年。结果，弗吉尼亚州越来越多地与社区设施合作和越来越多的 居住在痴呆症（VLWD）的退伍军人将获得社区和VA护理（双用户）。但是，有 双重使用退伍军人的护理差距，包括增加住院和碎片护理。 意义/影响： 了解社区护理双重使用的资深健康成果，护理质量和 安全至关重要，并提供了客观的任务法。我的CDA具有重要的潜力 发现当前的过渡护理差距，同时创建旨在减少的适应性，务实的干预措施 VLWD的不利结果。 创新： 我的CDA使用混合方法来告知识别不良过渡结果 VLWD和试点干预的改编。 VA由于 任务法。我的CDA研究在评估VLWD的社区护理方面具有创新性，是第一个评估的人 Mission Act时代VLWD的成果，​​并为改编的飞行员干预提供了信息。开发了方法 并在此CDA中应用将提供一个路线图，用于评估和比较护理环境的结果 同时还确定了障碍和促进者的护理过渡。 具体目标 目标1：了解双重使用VLWD的医疗保健利用模式和相关结果。 目标2：了解双重使用VLWD的偏好和过渡护理需求，他们的护理伙伴以及 临床医生通过定性访谈。 AIM 3：适应和试点测试基于证据的过渡护理模型，以改善过渡性护理结果 ED访问和/或住院后的VLWD。 这项工作得到了VA的支持 老年医学和扩展护理，社区护理和紧急情况的办公室 医学和 与VA优先级保持一致 - 研究重点是影响退伍军人护理的国家立法优先事项， 值得注意的是《任务法》。 方法论：我们将使用混合方法顺序定量到质量设计。首先，我们将表演 双重使用VLWD的定量研究，以了解导致不良结果的因素 住院，30天的ED再入院和死亡率在出院后30天内）。第二，我们会的 对双使用VLWD（n = 25），其家庭护理人员（n = 25）和临床医生进行定性研究（n = 25）确定过渡护理优先事项和需求。第三，我们将使用目标1和2的调查结果适应和 试点旨在减少VLWD不良后果的干预措施。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：此CDA发现将成为研究有效性和影响的未来工作的基础 资深结果。