Putting the puzzle together: Leveraging dual use to improve care for Veterans living with dementia

解决难题：利用双重用途改善对患有痴呆症的退伍军人的护理

基本信息

批准号：
10414417
负责人：
Sarah Krein
金额：
--
依托单位：
VETERANS HEALTH ADMINISTRATION
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10414417
关键词：
Aging Ambulatory Care Attention Caregivers Caring Case Manager Collaborations Communities Complex Continuity of Patient Care Data Dementia Dementia caregivers Drug Prescriptions Elderly Enrollment Family Goals Guidelines Health Health Services Accessibility Home Hospital Costs Individual Intervention Trial Interview Knowledge Learning Left Light Link Long-Term Care Medical center Medicare Medicare claim Methodology Methods Opioid Outcome Outpatients Patient-Focused Outcomes Patients Performance Pharmaceutical Preparations Policies Primary Health Care Provider Publishing Quality of Care Recording of previous events Research Personnel Research Priority Services Source Structure System Systems Development Time Variant Veterans Visit Voice Work care coordination care delivery care outcomes care seeking care systems caregiving dementia care design expectation experience high risk improved indexing innovation insight interest member military veteran opioid overdose person centered preference primary outcome programs psychosocial research and development skills tool

项目摘要

Background: The number of Veterans living with dementia (VLWD) will increase by 2030 to nearly 340,000; these VLWD and their caregivers often have complex psychosocial and health needs. Coordinating this care is complicated by the fact that most VLWD are Medicare-eligible and therefore use care both through the VA and Medicare. Unfortunately, dual use is often associated with duplication of services and potentially inappropriate care. In light of these complexities, VHA Directive 1140.12 from October 2019 mandated that VA facilities establish a Dementia System of Care to provide person-centered services for these VLWD. Because the design of dementia care services is left to individual VA facilities, national variation affords a unique opportunity to learn from particularly successful facilities. Significance: The proposed study will provide important new knowledge to advance the HSR&D priorities of long-term care/aging, access to care, and primary care practice. This knowledge will be achieved by linking patient-level VA data, Medicare claims, and the GECDAC Residential History File, enacting the VA Office of Research and Development’s Research Priority of putting VA data to work for Veterans. Innovation and Impact: This will be the first: (1) comprehensive analysis of non-VA care used by VLWD, including both Medicare- and VA-reimbursed community care; (2) analysis of dual use at the VA facility level, which is critical data for operational purposes; and (3) analysis of dementia care since the VHA Dementia System of Care directive. Finally, we will include the voice of VLWD and caregivers in both facility interviews and as Stakeholder Panel members. Specific Aims: (1) Characterize the associations of dual use and continuity of care with the Veteran-centered outcome of home time and how home time varies across VA facilities. (2) Assess facility-level strategies that promote home time and the acceptability of these strategies to Veterans and caregivers. (3) Develop a toolkit of dementia care strategies that facilities can use to enhance VLWD care delivery. Methodology: In this explanatory sequential mixed methods study, we will first identify community-dwelling VLWD and link their VA data and Medicare claims with the GECDAC Residential History File. Then, we will examine the association of dual use of outpatient and prescription medications with home time, and whether this is moderated by continuity of care. We will collapse these findings to examine dual use, continuity of care, and home time at the facility level. With input from a Stakeholder & Expert Panel, we will identify four high- and four low-performing VA facilities and conduct semi-structured interviews focused on local dementia care strategies with VA providers, VLWD-caregiver dyads, and a non-VA community care coordinator (n=9 interviews per facility). Finally, we will integrate our Aims 1 and 2 findings and, with Stakeholder & Expert Panel input, develop a dementia care toolkit consisting of strategies and tools that VA facilities can use to help implement their local Dementia System of Care. Next Steps/Implementation: The 2019 VHA Directive directing VA facilities to establish a local Dementia System of Care was not optional, but some facilities may have launched their systems more successfully than others. The toolkit developed during Aim 3 will provide additional guidance for challenging work facilities are already doing to improve the quality of care provided to VLWD.

背景：居住痴呆症（VLWD）的退伍军人人数将在2030年增加到将近340,000;这些VLWD及其护理人员通常具有复杂的社会心理和健康需要。大多数VLWD都是符合医疗保险资格的事实，协调这一护理变得复杂因此，通过VA和Medicare都使用护理。不幸的是，双重使用通常是与服务的重复和潜在的不当护理有关。鉴于这些复杂性，VHA指令1140.12，从2019年10月起，VA设施建立了一个痴呆症护理系统为这些VLWD提供以人为本的服务。因为痴呆症护理服务的设计留给了各个VA设施，国家变化为从特别成功的设施中学习的独特机会。意义：拟议的研究将提供重要的新知识，以促进长期护理/老龄化，获得护理和初级保健实践的HSR＆D优先事项。这通过将患者级的VA数据，Medicare主张和GECDAC链接来实现知识住宅历史档案，颁布了VA研究与发展研究办公室将VA数据用于退伍军人的优先级。创新和影响：这将是第一个：（1）对所使用的非VA护理的全面分析由VLWD，包括Medicare和VA赔偿的社区护理；（2）双重分析在VA设施级别使用，这是用于操作目的的关键数据；（3）分析痴呆症护理自VHA痴呆症护理指令系统以来。最后，我们将包括 VLWD的声音和设施访谈中的护理人员和作为利益相关者小组成员的声音。具体目的：（1）表征双重使用和护理连续性与以老兵为中心的家庭时间结果以及家庭时间在VA设施之间的变化。（2）评估促进家庭时间和这些策略的可接受性的设施级策略给退伍军人和看护人。（3）制定痴呆症护理策略工具包，设施可以用于增强VLWD护理交付。方法论：在此挖掘顺序混合方法研究中，我们将首先识别居住在社区的VLWD并将其VA数据和Medicare主张链接到GECDAC 住宅历史记录文件。然后，我们将研究门诊双重使用的关联有家庭时间的处方药，以及是否通过护理连续性来调节这一点。我们将崩溃这些发现，以检查双重使用，护理连续性和家庭时间设施水平。通过利益相关者和专家小组的投入，我们将确定四个高和四低表现的VA设施和进行半结构化访谈，重点是当地痴呆症 VA提供商，VLWD-Careiver Dyads和非VA社区护理的护理策略协调员（每个设施n = 9次访谈）。最后，我们将整合目标1和2的发现以及，使用利益相关者和专家小组的投入，开发由策略组成的痴呆症护理工具包 VA设施可以用来帮助实施其本地痴呆症护理体系的工具。下一步/实施：2019 VHA指令指导VA设施建立本地痴呆症护理系统不是可选的，但有些设施可能已经启动了他们的系统比其他系统更成功。 AIM 3期间开发的工具包将提供挑战工作设施的其他指南已经在提高质量提供给VLWD的护理。