Medical Foster Homes: A Safe, Cost Effective Substitute for Nursing Homes?

医疗寄养之家：安全、经济高效的疗养院替代品？

基本信息

批准号：
8399648
负责人：
Cari Renee Levy
金额：
--
依托单位：
VA EASTERN COLORADO HEALTH CARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8399648
关键词：
Accidents Address Adverse event Antipsychotic Agents Area Caregivers Caring Catchment Area Characteristics Choices and Control Clinical Cognitive Cognitive deficits Communities Data Data Set Databases Diagnostic Enrollment Ensure Environment Foster Home Care Fostering Funding Geriatrics Goals Home Nursing Care Home environment Hospitalization Individual Infection Inpatients Institutes Interview Life Long-Term Care Matched Group Medical Medical center Methods Modeling Normalcy Nurses Nursing Homes Nursing Research Outcome Outpatients Patient Care Persons Phase Physicians Policies Policy Maker Privacy Protocols documentation Qualifying Relative (related person)Research Research Personnel Safety Services Site Site Visit Structure Veterans Visit base care preference care seeking cohort cost cost effective design experience foster home holistic approach improved information gathering innovation medication compliance meetings operation preference programs success

项目摘要

DESCRIPTION (provided by applicant): Project Background: Since the program began in 2008, 1245 Veterans have received care in a MFH. The program has expanded from three sites in 2008 to 32 sites in 2010; 67 total sites are currently in some phase of initiating a program. The overall goals of this study are to inform VA policies pertaining to community based alternatives for LTC by understanding (1) how Veterans decide to receive care in a private home in the community rather than a traditional institutional setting; (2) which program attributes support their decision; (3) whether MFH is a safe alternative to NH placement; and (4) the costs associated with this model of care. Characterizing successful high-enrollment programs will inform changes to the model as it is nationally disseminated Objectives: Aim 1. Describe what leads Veterans to select or reject MFH placement over NH placement with the goal of assisting VHAs efficiently target recruitment into MFH programs by: Sub-Aim 1A. Comparing characteristics of Veterans residing in 3 high-enrollment MFH programs to the demographic, diagnostic, functional and cognitive characteristics of Veterans residing in NHs in the same VAMC catchment area. Sub-Aim 1B. Conducting in-person interviews with Veterans who have either recently enrolled or declined to enroll in one of 3 high-enrollment MFH programs. Sub-Aim 1C. Performing in-depth qualitative examinations of 3 high and 3 low-enrollment MFH programs to understand how MFH program attributes promote or thwart access to MFH enrollment. Aim 2. Assess safety of the MFH program by comparing adverse event rates among MFH enrollees to propensity matched MFH-eligible Veterans residing in NHs. Aim 3. Calculate VA budgetary costs for care, including non-programmatic inpatient and outpatient cost to the VA, of MFH enrollees compared to propensity-matched MFH-eligible Veterans living in NHs, and estimate total costs of MFH compared to non-MFH care. Methods: MFH residents will be compared to Veterans residing in NHs using data from the Minimum Data Set (MDS) in an unadjusted analysis. MDS data are available for NH residents but are not routinely collected for MFH residents. Thus, on-site research nurses will conduct MDS assessments directly for residents at 3 high- enrollment MFH programs to allow for comparisons of the MFH cohort to Veterans residing in NHs at the same VAMC (Sub Aim1A). Additionally, these on-site nurse researchers will interview 30 Veterans who entered and 30 who declined MFH entry within the last 30 days using a semi-structured protocol to understand the basis of their choices and preferences for care (Sub Aim 1B). In order to better understand why MFH programs have flourished in some areas while not in others, a team of qualitative researchers will undertake in-depth interviews with relevant VAMC administrative and clinical program officials during 2-day site visits at 3 high- enrollment and at 3 low-enrollment MFH programs (Sub Aim 1C). To address the issue of the relative safety of the MFH program versus the alternative of care in a NH, we will identify MFH users and compare the rate at which they experience avoidable hospitalizations, ED visits for accidents and exacerbations of medical conditions, infections, medication adherence and incident use of antipsychotics with a propensity matched group of NH residents drawn from similar medical centers that either had not instituted an MFH or had done so very late (Aim 2). Programmatic and non-programmatic costs of care will then be compared among these propensity matched subjects (Aim 3).

描述（由申请人提供）：项目背景：自该计划于2008年开始以来，有1245名退伍军人在MFH中获得了护理。该计划已从2008年的三个站点扩展到2010年的32个站点；目前，有67个站点正在启动程序的某个阶段。这项研究的总体目标是通过理解（1）退伍军人如何决定在社区中的私人住宅中获得护理，而不是传统的机构环境，以告知与LTC基于社区的替代方案有关的VA政策；（2）哪些程序属性支持他们的决定；（3）MFH是否是NH放置的安全替代品；（4）与这种护理模型相关的成本。表征成功的高注册计划将为模型的变更提供信息，因为它是全国传播的目标：AIM 1。描述是什么导致退伍军人选择或拒绝MFH放置在NH安置上，以帮助VHAS有效地将VHAS招募到MFH计划中，通过：SUB-AIM 1A。比较居住在3个高注册MFH计划中的退伍军人与居住在NHS中同一VAMC集水区中的退伍军人的人口，诊断，功能和认知特征的特征。 Sub-aim 1B。对最近入学或拒绝参加3个高注册MFH计划之一的退伍军人进行面对面访谈。 Sub-aim 1C。对3个高和3个低注册MFH计划进行深入的定性检查，以了解MFH程序属性如何促进或阻止对MFH入学率的访问。 AIM 2。通过比较MFH参与者之间的不良事件率与居住在NHS中的MFH合格的退伍军人，评估MFH计划的安全性。 AIM 3。计算VA的护理预算费用，包括与非MFH Care相比，与居住在NHS中的倾向匹配的MFH资深退伍军人相比，与倾向匹配的MFH资深退伍军人相比，MFH参与者的VA，MFH参与者的非涉及住院费和门诊费用。方法：在未经调整的分析中，将使用来自最小数据集（MDS）的数据将MFH居民与居住在NHS中的退伍军人进行比较。 MDS数据可用于NH居民，但并未针对MFH居民常规收集。因此，现场研究护士将直接针对3个高招生MFH计划的居民进行MDS评估，以允许将MFH队列与居住在NHS中的退伍军人进行比较（SUB AIM1A）。此外，这些现场护士研究人员将采访30名退伍军人，并使用半结构化协议在过去30天内拒绝MFH进入，以了解其选择和护理的偏好的基础（Sub AIM 1B）。为了更好地理解为什么MFH计划在某些领域而不是在其他领域中蓬勃发展，定性研究人员团队将在2天的高级入学率和3个低注册MFH MFH MFH MFH计划（Sub AIM 1C）进行2天的现场访问期间与相关的VAMC行政和临床计划官员进行深入的访谈。为了解决MFH计划相对安全问题与NH中的护理替代方案的问题，我们将确定MFH使用者并比较他们经历可避免的住院率的速度，对事故发生的事故访问，并加剧了医疗状况，感染，药物，药物遵守和事件的使用，与一组耐药的居民或其他相似的居民绘制的人相似，以此很晚（目标2）。然后，将在这些倾向匹配的受试者中比较程序化和非编程性护理成本（AIM 3）。