Evaluation of Veteran-Directed Home and Community Based Services

在接下来的十年里，退伍军人管理局需要为他们提供的老年退伍军人人数将翻一番 长期护理。以每年11万美元的长期护理费用计算，老年医学和长期护理(GEC)是 寻求在社区中维护退伍军人的独立性。VD-HCBS是以人为中心的消费者- 指导计划，为退伍军人提供自我指导其长期服务和支持的机会 (LTSS)，并继续在家里独立生活。GEC计划将VD-HCBS扩展到另外90个 VAMCS，并与基于证据的计划政策资源中心建立合作伙伴关系 (PEPReC)，用于随机、阶梯楔形传播和对利用结果的评价。这 这项提案将提供重要的成果和背景，以扩大多伦多-多氯联苯的规模。这样做的具体目的是 建议是：目标1：描述VD-HCBS对退伍军人的满意度、未满足的服务需求、 生活质量和独立性使用混合方法。目标1将利用运营数据来描述变化 退伍军人中报告的满意度、未满足的需求和独立于VD-HCBS的投保人数分别为3人和12人 月份。此外，我们还将对退伍军人进行采访，以记录他们在该计划中的经历。 目的2：了解VD-HCBS对照顾者幸福感的影响。Aim 2将比较照顾者的 经济压力、抑郁症状、护理压力、健康状况和积极的照顾者经历 从现有的退伍军人事务部数据到倾向匹配的人群，以确定VD-HCBS计划对 照顾者。目的3：检查VD-HCBS项目扩展的实施情况。目标3将利用 实施研究综合框架和实施专家建议 更改为来自VA和aDNA VD-HCBS对的采访协调员和其他关键线人。分析 将阐明背景因素和实施战略如何与实施和资深人员相关 结果。VD-HCBS有巨大的机会改善GEC LTSS的财务前景，同时提供 以退伍军人为中心的最高水平的关爱。与VD-HCBS的结果相一致，我们的实施 评估对于确定退伍军人制度如何与以社区为基础的 组织、实施计划并阐明重要的杠杆点以促进实施 有效性。随着不同团队的组建和综合评估的提出，我们将产生 为退伍军人管理局计划的实施和传播提供信息的证据，是退伍军人管理局优先事项的关键组成部分 开发高性能、高度可靠且一致的网络。

In the next decade, there will be a doubling of older Veterans for whom the VA has a requirement to provide long-term care. At a cost of $110,000 per year for long-term care, Geriatrics and Extended Care (GEC) is seeking to preserve Veteran independence in the community. VD-HCBS is a person-centered consumer- directed program that provides Veterans the opportunity to self-direct their long-term services and supports (LTSS) and continue to live independently at home. GEC is planning to expand VD-HCBS to an additional 90 VAMCs over the next 3 years and has partnered with the Program Evidenced-based Policy Resource Center (PEPReC) for a randomized, stepped-wedge dissemination and an evaluation of utilization outcomes. This proposal will provide important outcomes and context to the VD-HCBS expansion. The specific aims of this proposal are: Aim 1: To describe the impact of VD-HCBS on Veterans’ satisfaction, unmet need for services, quality of life and independence using mixed methods. Aim 1 will utilize operations data to describe the change in Veteran-reported satisfaction, unmet needs, and independence from enrollment in VD-HCBS to 3 and 12 months. Additionally, we will conduct interviews with Veterans to capture their experiences with the program. Aim 2: To understand the effect of VD-HCBS on Caregivers’ well-being. Aim 2 will compare Caregivers’ financial strain, depressive symptoms, caregiving stress, and health status and positive caregiver experiences to a propensity matched population from existing VA data to determine the impact of the VD-HCBS program on Caregivers. Aim 3: To examine the implementation of the VD-HCBS program expansion. Aim 3 will utilize the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change to interview coordinators, and other key informants, from VA and ADNA VD-HCBS pairs. The analysis will shed light on how contextual factors and implementation strategies relate to implementation and Veteran outcomes. VD-HCBS has tremendous opportunity to improve the fiscal outlook of GEC’s LTSS while delivering the highest level of Veteran-centered care. In concert with the outcomes of VD-HCBS, our implementation evaluation will be critical to determining how the VA system, in partnership with community-based organizations, implements programs and illuminating important leverage points to facilitate implementation effectiveness. With the diverse team assembled and the comprehensive evaluation proposed, we will produce evidence to inform VA program implementation and dissemination, a critical component of the VA’s priorities to develop high-performing, highly-reliable, and consistent networks.