Optimizing Transitions for Dual-Use Veterans Living with Dementia followingHospitalization in the Community

优化社区住院后患有痴呆症的两用退伍军人的过渡

基本信息

批准号：
10538945
负责人：
Roman Ayele
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：
2023
资助国家：
美国
起止时间：
2023-01-01 至 2027-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10538945
关键词：
Accident and Emergency department Address Adult Affect Alzheimer&apos s Disease American Area Behavior Benefits and Risks Caregivers Caring Chronic Communities Community Healthcare Community Hospitals Data Dementia Deterioration Development Emergency Medicine Emergency department visit Environment Evidence based intervention Face Family Caregiver Funding Future Geriatrics Goals Health Health Care Costs Health Services Accessibility Healthcare Home Homogeneously Staining Region Hospital Departments Hospitalization Hospitals Impairment Improve Access Incidence Institutionalization Intention Intervention Interview Investments Judgment Knowledge Language Length of Stay Long-Term Care Measures Medication Management Memory Methodology Methods Modeling Neurodegenerative Disorders Outcome Outcome Assessment Patient Care Patients Pattern Policies Post-Traumatic Stress Disorders Prevalence Quality of Care Recording of previous events Research Research Personnel Research Priority Resources Risk Risk Factors Safety Shapes System Testing Traumatic Brain Injury Veterans Veterans Health Administration Visit Work acceptability and feasibility acute care adverse outcome care coordination care fragmentation care outcomes care preference care systems career career development community based care community based service design effectiveness study effectiveness testing evidence base feasibility testing health care delivery health care service utilization high risk hospital care hospital readmission human old age (65+)implementation science improved improved outcome innovation mortality patient oriented pilot test poor health outcome pragmatic intervention preference prevent service delivery treatment as usual

项目摘要

Background: The Veterans Health Administration (VA) mandated expanded community care services for Veterans with the VA Maintaining Systems & Strengthening Integrated outside Networks (MISSION) Act of 2018. As a result, the VA has increasingly partnered with community-based facilities and growing number of Veterans Living with Dementia (VLWD) will receive community and VA care (dual-users). However, there are gaps in care for dual-use Veterans, including increased hospitalization and fragmented care. Significance/Impact: Understanding community care for dual-use Veteran health outcomes, care quality, and safety is crucial and provides objective measures of MISSION Act. My CDA is significant for its potential to uncover current transitional care gaps, while creating an adaptable, pragmatic intervention aimed at reducing adverse outcomes for VLWD. Innovation: My CDA uses mixed methods to inform the identification of adverse transitional outcomes among VLWD and the adaptation of a pilot intervention. The VA is undergoing a major transformation due to the MISSION Act. My CDA research is innovative in assessing community care for VLWD, is the first to assess outcomes for VLWD in the MISSION Act era and inform adapted pilot intervention. The methods developed and applied in this CDA will provide a roadmap for evaluating and comparing outcomes across care settings while also identifying barriers and facilitators to transitions in care. Specific Aims Aim 1: Understand health care utilization patterns and associated outcomes of dual-use VLWD. Aim 2: Understand preferences and transitional care needs of dual-use VLWD, their care partners, and clinicians through qualitative interviews. Aim 3: Adapt and pilot test an evidence-based transitional care model to improve transitional care outcomes for VLWD following ED visit and/or hospitalization. This work has the support of the VA offices of Geriatrics and Extended Care, community care and emergency medicine and aligns with VA priority-- research focused on national legislative priorities affecting Veteran care, notably the MISSION Act. Methodology: We will use a mixed methods sequential quantitative-to-qualitative design. First, we will perform a quantitative study of dual-use VLWD to understand factors that contribute to adverse outcomes (30-day re- hospitalizations, 30-day ED readmissions and mortality within 30 days of hospital discharge). Second, we will perform a qualitative study of dual-use VLWD (n = 25), their family caregivers (n = 25) and their clinicians (n = 25) to identify transitional care priorities and needs. Third, we will use findings from Aims 1 and 2 to adapt and pilot an intervention aimed at reducing adverse outcomes of VLWD. Using mixed-methods, we will test the feasibility and acceptability of the intervention. Next steps: This CDA findings will be the basis for future work to study the effectiveness and impact on Veteran outcomes.

背景：退伍军人健康管理局 (VA) 要求扩大社区护理服务退伍军人协会维护系统和加强综合外部网络 (MISSION) 法案 2018 年。因此，VA 越来越多地与社区设施和越来越多的社区机构合作患有痴呆症的退伍军人 (VLWD) 将接受社区和 VA 护理（双用户）。然而，有军民两用退伍军人护理方面存在差距，包括住院率增加和护理分散。意义/影响：了解社区护理对两用退伍军人的健康结果、护理质量和安全至关重要，并提供了 MISSION Act 的客观措施。我的 CDA 非常重要，因为它有潜力揭示当前的过渡性护理差距，同时制定适应性强、务实的干预措施，旨在减少 VLWD 的不良后果。创新：我的 CDA 使用混合方法来识别不良过渡结果 VLWD 和试点干预的调整。由于以下原因，VA 正在经历重大转型：使命法。我的 CDA 研究在评估 VLWD 的社区护理方面具有创新性，是第一个评估 MISSION Act 时代 VLWD 的结果，并为适应的飞行员干预提供信息。开发的方法并在此 CDA 中应用将为评估和比较不同护理环境的结果提供路线图同时还确定护理过渡的障碍和促进因素。具体目标目标 1：了解医疗保健利用模式和两用 VLWD 的相关结果。目标 2：了解两用 VLWD、他们的护理合作伙伴的偏好和过渡护理需求，以及临床医生通过定性访谈。目标 3：调整和试点测试基于证据的过渡性护理模式，以改善过渡性护理结果急诊科就诊和/或住院后的 VLWD。这项工作得到了 VA 的支持老年病学和延伸护理、社区护理和紧急情况办公室医学和与退伍军人管理局的优先事项保持一致——研究重点是影响退伍军人护理的国家立法优先事项，特别是《使命法》。方法：我们将使用混合方法顺序定量到定性设计。首先，我们将执行双重用途 VLWD 的定量研究，以了解导致不良结果的因素（30 天复查）住院治疗、30 天急诊室再入院和出院 30 天内死亡率）。其次，我们将对两用 VLWD (n = 25)、其家庭护理人员 (n = 25) 及其临床医生 (n = 25) 确定过渡性护理的优先事项和需求。第三，我们将利用目标 1 和 2 的发现来调整和调整试点一项旨在减少 VLWD 不良后果的干预措施。我们将使用混合方法来测试干预措施的可行性和可接受性。后续步骤：CDA 的研究结果将成为未来研究其有效性和影响的工作的基础老兵的成果。