Evaluating Cash Benefit Programs for Veterans' Long Term Care

这是为研究人员Kali Thomas博士申请HSR&D职业发展奖(CDA)的申请书 弗吉尼亚州普罗维登斯长期服务和支持创新中心(LTSS)的健康科学家 医疗中心。托马斯博士的长期职业目标是进行严格的研究，为政策和 旨在促进退伍军人管理局以家庭和社区为基础的服务提供的做法，从而改善 需要长期社会保障的退伍军人的生活质量和健康结果。预计退伍军人事务部对LTSS的需求将 随着退伍军人人口的老龄化，这一数字将继续大幅增长。本CDA将重点了解 退伍军人管理局提供的参与者导向(PD)现金福利计划，以满足对LTSS日益增长的需求。退伍军人事务部， 通过退伍军人健康管理局(VHA)和退伍军人福利管理局(VBA)，提供单独的 以及针对LTSS的独特的PD现金福利计划。VHA的退伍军人指导的家庭和社区 服务计划(VD-HCBS)根据退伍军人的残疾程度为他们提供每月预算 让他们有机会购买最符合他们需求的商品和服务。VBA提供两个 增加对领取养老金或补偿的残疾和返乡退伍军人的每月福利：援助 出勤率(A&A)和居家福利。在非退伍军人中，类似的计划也是有成本的- 有效和改善了参与者的结果。然而，在退伍军人事务部，有关有效性的信息和获得 这些计划是有限的：对谁获得这些PD现金福利仍然很少或根本不了解， 退伍军人如何利用这些福利，他们对福利的满意度，他们对医疗和医疗服务的消费 机构护理，以及与获得这些现金福利相关的结果。因此，它的目标是 本申请旨在为退伍军人事务部PD现金福利计划的研究奠定基础 制定旨在改善获得这些福利的机会的干预措施，促进国家对 退伍军人对这些好处的体验，并为研究生涯的评估和改进奠定了基础 向退伍军人发放长期生活保障计划。这项CDA将为托马斯博士提供必要的支持，以实现 以下目标：(1)成为进行严格、实用的方案评估和 实施研究；(2)熟练掌握比较有效性研究的基本数据 收集和定性研究方法(3)熟悉VAMC和 (4)实现研究自主性。这些目标将通过培训和应用，混合实现 方法她在该奖项中提出的形成性研究。具体地说，她的研究试图(1)使用 用于确定哪些医疗中心为哪些合格退伍军人提供服务的管理数据 PD现金福利方案，(2)探索VD-HCBS、A&A和居家登记人数不同的原因 通过采访VAMC人员获得VAMC的好处(3)与退伍军人进行访谈，以描述 他们与退伍军人管理局现金福利计划的经验和(4)建立退伍军人管理局的现金福利计划的有效性 现金福利计划通过使用复杂的方法来比较控制医疗成本 退伍军人的医疗保健利用率与接受传统LTSS的退伍军人的医疗利用率相当。这项研究具有重要的意义 因为它将提供对谁为PD护理获得退伍军人管理局现金福利的批判性理解，原因 差异，退伍军人对PD计划的看法，以及对其结果的了解。经验和技能 通过综合培训和研究计划获得的成果将加快托马斯博士长期- 学期研究目标，并将为实施创新解决方案奠定基础，以增加获得现金的机会 福利和获取退伍军人使用这些福利的经验的全国性图景，将在未来提出 优秀奖申请。托马斯博士目前和未来的研究将评估计划并实施 集成VHA和VBA的创新解决方案，创建一个VA系统以支持旧的、易受攻击的 退伍军人在他们选择的环境中获得适当的、以退伍军人为中心的、具有成本效益的LTSS。

This is an application for an HSR&D Career Development Award (CDA) for Dr. Kali Thomas, a Research Health Scientist in the Center of Innovation for Long-Term Services and Supports (LTSS) at the Providence VA Medical Center. Dr. Thomas' long-term career goal is to conduct rigorous research that will inform policies and practices aimed at advancing the VA's home and community-based service delivery, thereby improving the quality of life and health outcomes of Veterans needing LTSS. The demand for LTSS within VA is expected to continue to grow dramatically as the Veteran population ages. This CDA will focus on understanding the role of participant-directed (PD) cash benefit programs provided by VA to meet the growing need for LTSS. The VA, through its Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA), offers separate and distinct PD cash benefit programs for LTSS. The VHA's Veteran-Directed Home and Community Based Services program (VD-HCBS) provides Veterans with a monthly budget based on the extent of their disability giving them the opportunity to purchase goods and services that best meet their needs. The VBA offers two enhanced monthly benefits to disabled and homebound Veterans receiving pension or compensation: the Aid and Attendance (A&A) and Housebound benefits. In non-VA populations, similar programs have been cost- effective and improved participants' outcomes. However, in VA, information about effectiveness and access to these programs is limited: there remains little to no understanding of who receives these PD cash benefits, how Veterans are utilizing these benefits, their satisfaction with the benefits, their consumption of medical and institutional care, nor the outcomes associated with receiving these cash benefits. Therefore, the objective of this application is to establish a foundation of research about the VA's PD cash benefit programs in order to develop interventions aimed at improving access to these benefits, promote a national understanding of Veterans' experiences with these benefits, and set the stage for a research career evaluating and improving the delivery of LTSS to Veterans. This CDA will provide Dr. Thomas with the support necessary to accomplish the following goals: (1) to become an expert in conducting rigorous, practical program evaluation and implementation research; (2) to achieve proficiency in comparative effectiveness research, primary data collection, and qualitative research methodologies (3) to become familiar with delivery of LTSS at VAMCs and (4) to reach research independence. These goals will be achieved through the training and applied, mixed methods formative research she has proposed in this award. Specifically, her research seeks to (1) use administrative data to determine which eligible Veterans being served by which Medical Centers enroll in VA's PD cash benefit programs, (2) explore reasons for variation in enrollment in VD-HCBS, A&A and Housebound benefits across VAMCs with interviews of VAMC personnel (3) conduct interviews with Veterans to describe their experiences with the VA's PD cash benefit programs and (4) establish the effectiveness of the VA's PD cash benefit programs in controlling healthcare costs by using sophisticated methodologies to compare Veterans' healthcare utilization to that of Veterans receiving traditional LTSS. This research is significant because it will provide a critical understanding of who receives VA cash benefits for PD care, causes for variation, Veterans' perceptions of PD programs, and knowledge of their outcomes. The experience and skills gained through the integrated training and research plan will accelerate progress toward Dr. Thomas' long- term research goal and will set the stage for implementing innovative solutions to increase the access to cash benefits and obtaining a national picture of Veterans' experiences with these benefits, to be proposed in future Merit award applications. Dr. Thomas' current and future research will evaluate programs and implement innovative solutions to integrate VHA and VBA, creating a “One VA” system to enable older, vulnerable Veterans to receive appropriate, Veteran-centered, and cost-effective LTSS in the setting of their choice.