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 2008 年该计划启动以来，已有 1245 名退伍军人在 MFH 接受护理。该计划已从 2008 年的 3 个地点扩大到 2010 年的 32 个地点；目前共有 67 个站点处于启动计划的某个阶段。本研究的总体目标是通过了解 (1) 退伍军人如何决定在社区的私人住宅而不是传统的机构环境中接受护理，为退伍军人管理局关于基于社区的长期护理替代方案的政策提供信息； (2) 哪些计划属性支持他们的决定； (3) MFH 是否是 NH 安置的安全替代方案； (4) 与这种护理模式相关的费用。描述成功的高入学率计划的特点将为该模式的变化提供信息，因为它是在全国范围内传播的目标：目标 1. 描述是什么导致退伍军人选择或拒绝 MFH 安置而不是 NH 安置，目的是通过以下方式帮助 VHA 有效地瞄准 MFH 计划的招募： -瞄准1A。将居住在 3 个高入学率 MFH 计划中的退伍军人的特征与居住在同一 VAMC 流域内的 NH 中的退伍军人的人口、诊断、功能和认知特征进行比较。子目标 1B。对最近参加或拒绝参加 3 个高入学率 MFH 计划之一的退伍军人进行面对面采访。子目标 1C。对 3 个高入学率和 3 个低入学率 MFH 计划进行深入的定性检查，以了解 MFH 计划属性如何促进或阻碍 MFH 入学。目标 2. 通过比较 MFH 参与者与倾向匹配的居住在 NH 的符合 MFH 资格的退伍军人的不良事件发生率，评估 MFH 计划的安全性。目标 3. 计算 VA 的护理预算成本，包括 MFH 参保者与居住在 NH 的倾向匹配 MFH 资格退伍军人相比，VA 的非计划住院和门诊费用，并估算 MFH 与非 MFH 护理相比的总成本。方法：在未经调整的分析中，使用最小数据集 (MDS) 的数据将 MFH 居民与居住在 NH 的退伍军人进行比较。 MDS 数据可供 NH 居民使用，但不会定期收集 MFH 居民的数据。因此，现场研究护士将直接为 3 个高入学率 MFH 计划的居民进行 MDS 评估，以便将 MFH 队列与居住在同一 VAMC 的 NH 中的退伍军人进行比较（子目标 1A）。此外，这些现场护士研究人员将使用半结构化协议采访 30 名在过去 30 天内进入 MFH 的退伍军人和 30 名拒绝进入 MFH 的退伍军人，以了解他们选择和偏好护理的基础（子目标 1B）。为了更好地了解为什么 MFH 项目在某些领域蓬勃发展，而在其他领域却没有，定性研究人员团队将在 3 个高入学率和3 个低入学率 MFH 计划（子目标 1C）。为了解决 MFH 计划与 NH 中的替代护理相比的相对安全性问题，我们将确定 MFH 用户并比较他们经历本可避免的住院治疗、事故急诊室就诊以及医疗状况恶化、感染、药物治疗的比率抗精神病药物的依从性和事件使用情况与倾向匹配的 NH 居民组来自类似的医疗中心，这些中心要么没有建立 MFH，要么很晚才建立（目标 2）。然后将在这些倾向匹配的受试者中比较计划性和非计划性的护理成本（目标 3）。