Resilience to Covid-19 Disrupted Chronic Condition Care for Older Veterans At Risk of Hospitalization: Role of VA Ambulatory Care and VA Extended Care Home and Community-Based Care Supports

有住院风险的老年退伍军人对 Covid-19 中断的慢性病护理的恢复能力：VA 门诊护理和 VA 延伸护理之家和社区护理支持的作用

• 批准号: 10632920
• 负责人: Lillian Chiang Min
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10632920
• 关键词: Acute; Admission activity; Adult; Affect; Age; Ambulatory Care; Ambulatory Care Facilities; COVID-19; COVID-19 impact; COVID-19 pandemic; Cardiovascular system; Caring; Chronic; Chronic Disease; Clinic Visits; Clinical; Communities; Congestive Heart Failure; Coupled; Data; Data Analyses; Data Sources; Day Care; Diet; Discipline of Nursing; Disease Management; Elderly; Fall prevention; Future; Geographic Locations; Health; Health Care Research; Healthcare; Healthcare Systems; Heart failure; Home; Home Health Aides; Hospital Mortality; Hospitalization; Hospitals; Hypertension; Impairment; Improve Access; Institutionalization; Long-Term Care; Longitudinal Studies; Managed Care; Measures; Medical; Medical center; Medicare; Medicare claim; Medicare/Medicaid; Methodology; Methods; Monitor; Natural experiment; Occupational Therapy; Office Visits; Outcome; Outpatients; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmacy facility; Physical Rehabilitation; Physical therapy; Press Releases; Primary Care; Productivity; Provider; Recovery; Research; Risk; Role; Self Care; Services; Social Work; Social support; Sodium Chloride; Subgroup; Telephone; Testing; Time; Transportation; Vaccines; Variant; Veterans; Visit; Workload; aged; analytical tool; care systems; clinical outcome assessment; community based care; community based service; experience; fall injury; falls; health care delivery; health care service; high risk; human old age (65+); innovation; insight; medical specialties; medication compliance; novel; pandemic disease; patient home care; patient population; poor health outcome; pre-pandemic; preservation; prevent; programs; rehabilitation service; resilience; respite care; service delivery; service programs; skills; team-based care; tool; video visit; virtual; virtual visit

Background: The Covid-19 pandemic disrupted the ambulatory health care of Veterans with chronic conditions, including those with the highest need for VA care. Significance/Impact: This research will study the critical role of the VA healthcare system for delivering chronic disease management during the pandemic, including office, video, and telephone care, and assess clinical outcomes of older Veterans at the highest risk for hospitalizations for chronic disease exacerbations and acute fall injuries. In addition, we will explore how VA Geriatric Extended Care Home and Community- Based Services (HCBS) mitigated Covid-19 related healthcare disruptions. Innovation: This research will implement the newest analytic tools for studying health outcomes of older Veterans, approaches to measure access to VA HCBS programs, and identify those at highest risk of disrupted and delayed chronic disease care. Specific Aims: Using state-of-the-art methods, we will address the following Aims: Aim 1A: Examine the effect of disrupted ambulatory care visits on chronic condition management (CCM) for older Veterans. We will identify changes over time (“disruption”) in ambulatory care, including the volume of face-to-face and virtual visits, video and telephone calls, that are provided by outpatient primary and specialty care outpatient clinics. We will study ~ 1 million older (age ≥65) Veterans with at least 1 of 3 chronic medical and geriatric conditions: hypertension, congestive heart failure (CHF), or falls/mobility impairment during the Covid-19 crisis (2020-21). Management of chronic conditions will be measured by medication adherence, intensity, lab monitoring, and physical therapy services. Vulnerability to service disruption will be defined using the established method in VA patients and two other methods developed specifically for geriatric patient populations, the Predicted Long-term Institutionalization (PLI) measure. Next, in Aim 1B, we will test whether facilities who were able to maintain better access to HBCS mitigated the effect of disrupted ambulatory care on performance of chronic condition care management. This critical Aim will focus on 5 HBCS programs: Home-Based Primary Care, Personal Care Services (homemaker and home health aides, respite care), Veteran Directed Care, Adult Day Care, and Skilled Home Care (e.g., physical and occupational therapy, nursing, social work) Aim 2: Examine the effect of chronic condition management disruption on hospitalizations for ACSCs and acute fall injuries. We will determine whether older Veterans with less disrupted care during the initial and second Covid-19 surges also had a lower risk of hospitalization for chronic ACSC-related hospitalizations related to CHF and hypertension or for a fall-related injury. This Aim will result in a better understanding of how to predict hospitalization for ACSCs among older Veterans according to vulnerability. Methodology: This is a longitudinal study of older Veterans in the national VA healthcare system, using VA healthcare data merged with Medicare and Medicaid long-term care data, and pharmacy files from the VA and Medicare. We will use risk scores and data sources in partnership with the GEC Data Analysis Center. Next Steps: We will identify the chronic condition management services that should be prioritized for older Veterans and a potential roadmap for how the future VA ambulatory care and GEC healthcare systems can partner to provide better chronic condition management and attain better health outcomes for older Veterans.

背景：2019冠状病毒病大流行扰乱了退伍军人的门诊医疗保健， 条件，包括那些最需要VA护理。 意义/影响：本研究将研究VA医疗保健系统在提供 大流行期间的慢性病管理，包括办公室、视频和电话护理，并评估 因慢性疾病加重住院风险最高的老年退伍军人的临床结局 和急性坠落伤此外，我们将探讨如何VA老年延伸护理之家和社区- 基于服务（HCBS）减轻了与COVID-19相关的医疗中断。 创新：这项研究将采用最新的分析工具来研究老年人的健康状况。 退伍军人，方法来衡量访问VA HCBS计划，并确定那些在最高风险的中断 和慢性病护理延迟。 具体目标：使用最先进的方法，我们将实现以下目标： 目的1A：检查中断的门诊治疗对慢性病管理的影响 (CCM)对于老退伍军人。我们将确定门诊护理随时间的变化（“中断”），包括 门诊初级和初级保健机构提供的面对面和虚拟就诊、视频和电话呼叫量 专科护理门诊。我们将研究约100万老年（年龄≥65岁）退伍军人，其中至少有1/3的慢性 医学和老年疾病：高血压、充血性心力衰竭（CHF）或福尔斯/活动障碍 在Covid-19危机期间（2020-21年）。慢性病的管理将通过药物治疗来衡量 依从性、强度、实验室监测和物理治疗服务。服务中断的脆弱性将 使用VA患者的既定方法和专门针对VA患者开发的另外两种方法定义 老年患者人群，预测长期机构化（PLI）措施。接下来，在目标1B中， 将测试能够更好地访问HBCS的设施是否减轻了 中断门诊护理对慢性病护理管理的影响。这一关键目标将 专注于5个HBCS计划：以家庭为基础的初级保健，个人护理服务（家庭主妇和家庭 健康助理，喘息护理），退伍军人指导护理，成人日托，和熟练的家庭护理（例如，物理和 职业治疗、护理、社会工作） 目的2：检查慢性病管理中断对ACSC住院的影响 和急性坠落伤我们将确定在最初的治疗期间， 第二次COVID-19激增也降低了慢性ACSC相关住院的风险 与CHF和高血压相关或与跌倒相关的损伤。这一目标将有助于更好地了解 如何根据脆弱性预测老年退伍军人中ACSC的住院率。 方法：这是一项使用VA对国家VA医疗保健系统中的老年退伍军人进行的纵向研究 医疗保健数据与医疗保险和医疗补助长期护理数据合并，以及来自VA的药房文件， 医疗保险我们将与GEC数据分析中心合作使用风险评分和数据源。 下一步：我们将确定应优先为老年人提供的慢性病管理服务 退伍军人和未来VA门诊护理和GEC医疗保健系统如何 合作伙伴提供更好的慢性病管理，并为老年退伍军人获得更好的健康结果。