Post-Acute Home Health Care for Veterans: Examining Payer Source, Quality, and Outcomes

退伍军人急性后家庭医疗保健：检查付款人来源、质量和结果

基本信息

批准号：
10426941
负责人：
Stefan Gravenstein
金额：
--
依托单位：
PROVIDENCE VA MEDICAL CENTER
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：
2022-07-01 至 2026-09-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10426941
关键词：
Acute Admission activity Affect Americas Area Caregivers Caring Characteristics Collaborations Communities Complex Contracts Data Development Discipline of Nursing Effectiveness Enrollment Foundations Funding Geriatrics Goals Growth Health Health Personnel Health Policy Healthcare Home Home Care Services Home Health Agency Home Health Care Agencies Hospitalization Hospitals Human Resources Independent Living Interview Knowledge Leadership Long-Term Care Measures Mediating Medical center Medicare Methodology Methods Mission Modeling Nursing Homes Outcome Pathway interactions Pattern Personal Satisfaction Policies Process Provider Qualitative Research Quality of Care Recommendation Research Research Design Research Methodology Resources Risk Services Shapes Site Visit Social Work Source Structure Techniques Testing Veterans Work adverse outcome care coordination care outcomes care systems cost experience health care cost/financing health care referral health care service health care service utilization high risk high risk population hospital readmission improved improved functioning innovation insight mortality patient home care patient population primary outcome provider networks readmission rates service delivery shared decision making stakeholder perspectives tool

项目摘要

PROJECT SUMMARY/ABSTRACT Background. Veterans are at increased risk of adverse outcomes after hospital discharge, including rehospitalization, nursing home admission, and mortality. Post-acute skilled home health care (HHC) can provide critical support for Veterans following a hospitalization. The services provided through HHC, including nursing and therapies, can help Veterans meet their goals to improve function, well-being, and return to independent living in their homes. For Medicare-eligible Veterans, skilled HHC is provided through 1) VA purchased skilled HHC from a contracted HHC agency or 2) Medicare-funded HHC (i.e., Part A benefit, Medicare Advantage). Preliminary work suggests that the majority (66%) of Veterans discharged home from VA Medical Centers (VAMCs) with skilled HHC receive VA-contracted skilled HHC and the remainder receive Medicare-funded HHC. However, funding for skilled HHC varies substantially across VAMCs, with implications both for HHC service delivery and Veterans’ outcomes. In preliminary work, we found that 30-day readmissions are higher among Veterans who receive VA-financed HHC compared to Medicare-financed HHC, which could be related to HHC agency quality. Significance/Impact. A better understanding of HHC referrals and financing, which has always been purchased and delivered by community HHC agencies, could provide key insights for the VA given the growth in community care for Veterans. Because community home health agencies have always provided post-acute HHC, this context provides an ideal opportunity to examine interorganizational partnerships and Veterans’ outcomes. The proposed research will characterize post-acute HHC use, financing, and quality of care, and how these factors are associated with outcomes for Veterans discharged from VAMCs, as well as providers’ and Veterans’ experiences of delivering and receiving post-acute HHC. Findings will inform the development of a toolkit for VA and HHC leaders with resources to guide high-value HHC agency selection and collaboration. The contribution of this research is significant because the results will directly inform how operational partners choose HHC agencies to include in provider networks and develop policy for skilled HHC referrals, and will also provide practical tools for multiple stakeholders to provide optimal HHC for Veterans. Innovation. This is the first comprehensive study to examine VA contracting, referral practices, and financing - including both VA and Medicare - to understand their influence on Veterans’ outcomes. A stakeholder- engaged, complex mixed-methods study design is used to understand the mechanisms and processes that shape the use and outcomes of post-acute HHC from multiple perspectives. Specific Aims. 1) Identify determinants of VA vs Medicare-financed post-acute skilled HHC among community dwelling Medicare-enrolled Veterans; 2) Understand multiple stakeholders’ perspectives on older Veterans’ use of post-acute skilled HHC and factors that influence the delivery of HHC; 3) Determine the impact of home health agency quality and HHC payer source on differences in outcomes for older Veterans receiving post- acute HHC. Methodology. This proposal uses a complex mixed-methods study design with advanced statistical techniques and comprehensive VA and Medicare administrative data, as well as a robust qualitative approach to interview stakeholders from VAMCs, HHC agencies, Veterans, and caregivers to accomplish our aims. Implementation/Next Steps. The culmination of findings from this work will be incorporated into a toolkit to promote high-value HHC selection and collaboration. In addition, this work will form the foundation for a large- scale study to develop and test implementation and effectiveness of a shared decision-making model for Veterans and VAMC personnel to promote high-value HHC.

项目概要/摘要背景退伍军人出院后出现不良后果的风险增加，包括再住院、入住疗养院和死亡率。为退伍军人住院后提供重要支持通过 HHC 提供的服务，包括护理和治疗，可以帮助退伍军人实现改善功能、福祉和重返社会的目标对于符合 Medicare 资格的退伍军人，通过 1) VA 提供熟练的 HHC。从签约的 HHC 机构购买了熟练的 HHC，或 2) 医疗保险资助的 HHC（即 A 部分福利、医疗保险优势）的初步工作表明，大多数（66%）退伍军人已出院回家。拥有熟练 HHC 的 VA 医疗中心 (VAMC) 接收与 VA 签约的熟练 HHC，其余的则接收然而，医疗保险资助的 HHC 在各个 VAMC 中对熟练 HHC 的资助差异很大，这会产生影响。在初步工作中，我们发现 HHC 服务提供和退伍军人的结果会出现 30 天的再入院情况。与 Medicare 资助的 HHC 相比，接受 VA 资助的 HHC 的退伍军人的死亡率更高，这可能与 HHC 机构质量相关。意义/影响。更好地了解 HHC 转介和融资，这一直是由社区 HHC 机构购买和交付，鉴于增长，可以为 VA 提供关键见解因为社区家庭健康机构一直在为退伍军人提供社区护理服务。 HHC，这种背景提供了一个理想的机会来检查组织间伙伴关系和退伍军人的拟议的研究将描述急性后 HHC 的使用、融资和护理质量，以及这些因素与从 VAMC 退伍的退伍军人的结果有何关系，以及提供者的退伍军人交付和接受急性 HHC 后的经验将为发展提供信息。为 VA 和 HHC 领导者提供的工具包，提供指导高价值 HHC 机构选择和合作的资源。这项研究的贡献是重大的，因为结果将直接告知运营合作伙伴如何选择 HHC 机构纳入提供商网络并制定熟练 HHC 转介政策，并将还为多个利益相关者提供实用工具，为退伍军人提供最佳的 HHC。创新。这是第一个检查 VA 合同、转介实践和融资的综合研究 - 包括 VA 和医疗保险 - 了解它们对退伍军人结果的影响利益相关者 - 参与式、复杂的混合方法研究设计用于理解从多个角度塑造急性后 HHC 的使用和结果。具体目标 1) 确定社区中 VA 与医疗保险资助的急性后熟练 HHC 的决定因素参加医疗保险的退伍军人；2) 了解多个利益相关者对老年退伍军人的看法急性后熟练 HHC 的使用以及影响 HHC 交付的因素 3) 确定家庭的影响；卫生机构质量和 HHC 付款人来源了解老年退伍军人接受后治疗结果的差异急性 HHC。该提案采用了具有先进统计的复杂混合方法研究设计。技术和全面的 VA 和医疗保险管理数据，以及强大的定性方法采访 VAMC、HHC 机构、退伍军人和护理人员的利益相关者，以实现我们的目标。实施/后续步骤这项工作的成果将被纳入一个工具包中促进高价值 HHC 选择和合作。此外，这项工作将为大型项目奠定基础。规模研究，以开发和测试共享决策模型的实施有效性退伍军人和 VAMC 人员推广高价值 HHC。