Resilience to Covid-19 Disrupted Chronic Condition Care for Older Veterans At Risk of Hospitalization: Role of VA Ambulatory Care and VA Extended Care Home and Community-Based Care Supports

有住院风险的老年退伍军人对 Covid-19 中断的慢性病护理的恢复能力：VA 门诊护理和 VA 延伸护理之家和社区护理支持的作用

• 批准号: 10632920
• 负责人: Lillian Chiang Min
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10632920
• 关键词: Acute; Admission activity; Adult; Affect; Age; Ambulatory Care; Ambulatory Care Facilities; COVID-19; COVID-19 impact; COVID-19 pandemic; Cardiovascular system; Caring; Chronic; Chronic Disease; Clinic Visits; Clinical; Communities; Congestive Heart Failure; Coupled; Data; Data Analyses; Data Sources; Day Care; Diet; Discipline of Nursing; Disease Management; Elderly; Fall prevention; Future; Geographic Locations; Health; Health Care Research; Healthcare; Healthcare Systems; Heart failure; Home; Home Health Aides; Hospital Mortality; Hospitalization; Hospitals; Hypertension; Impairment; Improve Access; Institutionalization; Long-Term Care; Longitudinal Studies; Managed Care; Measures; Medical; Medical center; Medicare; Medicare claim; Medicare/Medicaid; Methodology; Methods; Monitor; Natural experiment; Occupational Therapy; Office Visits; Outcome; Outpatients; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmacy facility; Physical Rehabilitation; Physical therapy; Press Releases; Primary Care; Productivity; Provider; Recovery; Research; Risk; Role; Self Care; Services; Social Work; Social support; Sodium Chloride; Subgroup; Telephone; Testing; Time; Transportation; Vaccines; Variant; Veterans; Visit; Workload; aged; analytical tool; care systems; clinical outcome assessment; community based care; community based service; experience; fall injury; falls; health care delivery; health care service; high risk; human old age (65+); innovation; insight; medical specialties; medication compliance; novel; pandemic disease; patient home care; patient population; poor health outcome; pre-pandemic; preservation; prevent; programs; rehabilitation service; resilience; respite care; service delivery; service programs; skills; team-based care; tool; video visit; virtual; virtual visit

Background: The Covid-19 pandemic disrupted the ambulatory health care of Veterans with chronic conditions, including those with the highest need for VA care. Significance/Impact: This research will study the critical role of the VA healthcare system for delivering chronic disease management during the pandemic, including office, video, and telephone care, and assess clinical outcomes of older Veterans at the highest risk for hospitalizations for chronic disease exacerbations and acute fall injuries. In addition, we will explore how VA Geriatric Extended Care Home and Community- Based Services (HCBS) mitigated Covid-19 related healthcare disruptions. Innovation: This research will implement the newest analytic tools for studying health outcomes of older Veterans, approaches to measure access to VA HCBS programs, and identify those at highest risk of disrupted and delayed chronic disease care. Specific Aims: Using state-of-the-art methods, we will address the following Aims: Aim 1A: Examine the effect of disrupted ambulatory care visits on chronic condition management (CCM) for older Veterans. We will identify changes over time (“disruption”) in ambulatory care, including the volume of face-to-face and virtual visits, video and telephone calls, that are provided by outpatient primary and specialty care outpatient clinics. We will study ~ 1 million older (age ≥65) Veterans with at least 1 of 3 chronic medical and geriatric conditions: hypertension, congestive heart failure (CHF), or falls/mobility impairment during the Covid-19 crisis (2020-21). Management of chronic conditions will be measured by medication adherence, intensity, lab monitoring, and physical therapy services. Vulnerability to service disruption will be defined using the established method in VA patients and two other methods developed specifically for geriatric patient populations, the Predicted Long-term Institutionalization (PLI) measure. Next, in Aim 1B, we will test whether facilities who were able to maintain better access to HBCS mitigated the effect of disrupted ambulatory care on performance of chronic condition care management. This critical Aim will focus on 5 HBCS programs: Home-Based Primary Care, Personal Care Services (homemaker and home health aides, respite care), Veteran Directed Care, Adult Day Care, and Skilled Home Care (e.g., physical and occupational therapy, nursing, social work) Aim 2: Examine the effect of chronic condition management disruption on hospitalizations for ACSCs and acute fall injuries. We will determine whether older Veterans with less disrupted care during the initial and second Covid-19 surges also had a lower risk of hospitalization for chronic ACSC-related hospitalizations related to CHF and hypertension or for a fall-related injury. This Aim will result in a better understanding of how to predict hospitalization for ACSCs among older Veterans according to vulnerability. Methodology: This is a longitudinal study of older Veterans in the national VA healthcare system, using VA healthcare data merged with Medicare and Medicaid long-term care data, and pharmacy files from the VA and Medicare. We will use risk scores and data sources in partnership with the GEC Data Analysis Center. Next Steps: We will identify the chronic condition management services that should be prioritized for older Veterans and a potential roadmap for how the future VA ambulatory care and GEC healthcare systems can partner to provide better chronic condition management and attain better health outcomes for older Veterans.

背景：Covid-19大流行破坏了老兵的卧床医疗保健 条件，包括对VA护理需求最高的条件。 意义/影响：这项研究将研究VA医疗系统在交付的关键作用 大流行期间的慢性疾病管理，包括办公室，视频和电话护理以及评估 老年退伍军人的临床结局，处于慢性疾病加剧的住院风险最高 和急性跌倒受伤。此外，我们将探讨VA老年延长护理之家和社区如何 基于服务（HCBS）减轻了COVID-19相关的医疗保健中断。 创新：这项研究将实施最新的分析工具来研究老年人的健康结果 退伍军人，衡量访问VA HCBS计划的方法，并确定那些处于中断风险的风险 并延迟慢性病护理。 具体目的：使用最新方法，我们将解决以下目的： AIM 1A：检查中断的门诊护理访问对慢性状况管理的影响 （CCM）对于老年退伍军人。我们将在卧床护理中确定随着时间的变化（“破坏”），包括 面对面和虚拟访问，视频和电话的数量，由门诊小学提供 专业护理门诊诊所。我们将研究约100万（年龄≥65岁）的退伍军人，至少有3个慢性 医学和老年病症：高血压，充血性心力衰竭（CHF）或跌倒/流动性障碍 在19020-21危机期间。慢性病的管理将通过药物来衡量 依从性，强度，实验室监测和物理治疗服务。服务中断的脆弱性将 使用VA患者的既定方法定义 老年患者人群，预测的长期制度化（PLI）测量。接下来，在AIM 1B中，我们 将测试能够更好地访问HBC的设施是否会减轻效果 慢性病护理管理绩效的卧床护理中断。这个关键的目标 专注于5个HBCS计划：家庭基础护理，个人护理服务（家庭主妇和家庭 卫生助手，喘息的护理），老将定向护理，成人日托和熟练的家庭护理（例如，身体和身体护理 占领治疗，护士，社会工作） 目标2：检查慢性病管理中断对ACSC住院的影响 和急性跌倒受伤。我们将确定在初始医疗期间的老年退伍军人是否干扰了 第二次Covid-19也有较低的与ACSC相关住院治疗的住院风险较低 与CHF和高血压有关或与跌倒有关的损伤有关。这个目标将使人们更好地理解 如何根据脆弱性预测老年退伍军人的ACSC住院。 方法论：这是对国家VA医疗保健系统中老年退伍军人的纵向研究，使用VA 医疗保健数据与Medicare和Medicaid长期护理数据合并，以及来自VA的药房文件 Medicare。我们将与GEC数据分析中心合作使用风险评分和数据源。 下一步：我们将确定应优先考虑较老的慢性条件管理服务 退伍军人和未来VA门诊护理和GEC医疗保健系统的潜在路线图 合作伙伴提供更好的慢性病管理，并为老年退伍军人提供更好的健康成果。