Does VA Home-Based Primary Care Reduce Costs Among Veterans Eligible for Independence at Home?

退伍军人管理局基于家庭的初级保健是否可以降低有资格在家独立的退伍军人的费用？

基本信息

批准号：
10308432
负责人：
CIARAN S. PHIBBS
金额：
--
依托单位：
VETERANS ADMIN PALO ALTO HEALTH CARE SYS
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-10-01 至 2021-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10308432
关键词：
Admission activity Affect Caring Clinical Control Groups Cost Savings Data Diagnosis Economics Effectiveness Emergency Care Enrollment Evaluation Expenditure Frail Elderly Geriatrics Goals Government Health Health Care Costs Healthcare Home Institutionalization Intervention Leadership Long-Term Care Measures Medicaid Medicare Medicare/Medicaid Methods Needs Assessment Nursing Homes Outcome Patients Policies Prevalence Primary Health Care Provider Qualifying Resources Risk Savings Services Subgroup Testing Time Variant Veterans base beneficiary cohort comparison group cost cost effective frailty functional status group intervention health service use hospital readmission hospitalization rates improved outcome indexing innovation older patient operation primary care services program costs programs relative effectiveness routine care service utilization tool

项目摘要

Anticipated Impacts on Veteran's Healthcare: The Medicare Independence-at-Home (IAH) demonstration which provides frail elderly patients with provider-managed integrated care and supportive services at home has shown reduced rates of hospitalizations, 30-day rehospitalizations, emergency department care, and an average $3,070 annual costs savings per patient. This study will examine if VA's Home Based Primary Care (HBPC) program, the inceptor of IAH, produces similar outcomes among Veterans who meet IAH qualifying criteria (IAH-Q). High HBPC program costs have limited the availability of HBPC and it is currently serving less than 25% of Veterans who meet IAH-Q. This project will provide the Offices of Geriatrics and Extended Care (GEC) Policy (10P4G) and Operations (10NC4) with information needed to make informed decisions about effective expansion of the HBPC program, and tools to target Veterans who will benefit from it most. Project Background: The IAH demo is associated with better outcomes and reduced healthcare costs compared to routine care. While VA has operated the HBPC program since the 1970s, it only serves a fraction of the Veterans who meet the Medicare IAH-Q. VA has expanded HBPC from operating in less than half its facilities in 2000 to almost all facilities today. However, the program's reach is still constrained because of the relatively large up-front costs and the lack of readily applicable admission criteria to identify those who would benefit from the program. Further, since over half of the current HBPC enrollees do not meet the IAH-Q, VA needs information on which Veterans should be considered for HBPC so that the program can be available to those Veterans who will likely achieve the most clinical and economic benefit. Project Objectives: One: Does VA's HBPC, when targeted to IAH-Q Veterans, achieve the same clinical outcomes and cost savings as Medicare's IAH-Q beneficiaries receiving Medicare HBPC? Two: Extend the evaluation methods to exploit VA data that was not available to the Medicare evaluation, and include alternative estimation methods to test the robustness of the findings. Three: VA currently provides HBPC to Veterans who do not meet IAH-Q criteria. What is the effectiveness of HBPC in these other groups? Are there non-IAH-Q groups of Veterans for whom HBPC would be cost- effective? Further, what is the variability in the effectiveness of HBPC among IAH-Q Veterans? Four: Develop targeting criteria equivalent to IAH-Q that use only VA data, without relying on data from CMS, to identify Veterans for HBPC enrollment, including refinement of IAH-Q criteria with VA risk measures such as JEN Frailty Index and CAN scores. Five: The CMS demonstration project considered only Medicare expenditures. How does HBPC care affect utilization and costs across Medicare, Medicaid and VA? Project Methods: This project will use Medicare, Medicaid and VA data to capture all relevant utilization and diagnoses. We will identify all Veterans who were potentially eligible for HBPC in 2011. The intervention cohort will be all Veterans who received HBPC in 2012. The control group will be determined from those potentially eligible Veterans who did not use HBPC in 2012 using a direct demographic match, with a propensity score matching based on diagnoses, health services utilization, treatments and prescriptions and MDS or OASIS frailty assessments. We will follow both groups through 2015, comparing functional status, utilization of services, and costs.

对退伍军人医疗保健的预期影响：医疗保险在家独立 (IAH) 示威为体弱的老年患者提供由医疗服务提供者管理的综合护理和家庭支持服务住院率、30 天再住院率、急诊科护理率和每个患者每年平均节省 3,070 美元的费用。这项研究将检查 VA 的家庭初级保健是否 (HBPC) 计划是 IAH 的发起者，在符合 IAH 资格的退伍军人中产生了类似的结果标准（IAH-Q）。 HBPC 计划成本高昂限制了 HBPC 的可用性，目前服务较少超过 25% 的退伍军人符合 IAH-Q。该项目将提供老年病学和延伸护理办公室 (GEC) 政策 (10P4G) 和运营 (10NC4)，提供做出明智决策所需的信息有效扩展 HBPC 计划，并提供针对从中受益最大的退伍军人的工具。项目背景：IAH 演示与更好的结果和降低的医疗成本相关与常规护理相比。虽然 VA 自 20 世纪 70 年代以来一直在运营 HBPC 计划，但它只服务于一小部分符合 Medicare IAH-Q 的退伍军人。 VA 已将 HBPC 的运营范围扩大到不到其一半 2000 年的设施发展到今天的几乎所有设施。然而，该计划的覆盖面仍然受到限制，因为相对较大的前期成本，并且缺乏易于适用的准入标准来识别那些愿意从该计划中受益。此外，由于超过一半的当前 HBPC 参与者不符合 IAH-Q，VA 需要有关哪些退伍军人应考虑参加 HBPC 的信息，以便该计划可供那些可能会获得最大临床和经济效益的退伍军人。项目目标：一：VA 的 HBPC 在针对 IAH-Q 退伍军人时是否能达到相同的临床效果作为 Medicare 的 IAH-Q 受益人接受 Medicare HBPC 的结果和成本节省？二：扩展评估方法以利用医疗保险评估无法获得的 VA 数据，以及包括替代估计方法来测试研究结果的稳健性。三：VA 目前向不符合 IAH-Q 标准的退伍军人提供 HBPC。功效是什么 HBPC 在这些其他组中吗？是否有非 IAH-Q 退伍军人群体的 HBPC 成本较高？有效的？此外，IAH-Q 退伍军人中 HBPC 的有效性有何差异？四：制定相当于 IAH-Q 的目标标准，仅使用 VA 数据，而不依赖 CMS 的数据，确定退伍军人参加 HBPC 登记，包括通过 VA 风险措施细化 IAH-Q 标准，例如 JEN 虚弱指数和 CAN 分数。五： CMS 示范项目仅考虑医疗保险支出。 HBPC 护理有何影响医疗保险、医疗补助和 VA 的利用率和成本？项目方法：该项目将使用 Medicare、Medicaid 和 VA 数据来获取所有相关的利用率和诊断。我们将确定 2011 年可能有资格参加 HBPC 的所有退伍军人。干预队列将是所有在 2012 年接受 HBPC 的退伍军人。对照组将从那些可能接受过 HBPC 的退伍军人中确定 2012 年未使用 HBPC 的合格退伍军人直接人口统计匹配，并带有倾向得分基于诊断、卫生服务利用、治疗和处方以及 MDS 或 OASIS 的匹配脆弱性评估。我们将在 2015 年跟踪这两个群体，比较功能状态、利用率服务和费用。