Helping VA optimize its long-term care services

帮助 VA 优化其长期护理服务

• 批准号: 10689724
• 负责人: JOSEPHINE JACOBS
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10689724
• 关键词: Address; Adult; Affect; Ambulatory Care; Area; Budgets; Caregiver support; Caregivers; Caring; Characteristics; Collaborations; Computerized Medical Record; Contract Services; Contractor; Contracts; Data Sources; Databases; Discipline of Nursing; Econometric Models; Effectiveness; Equilibrium; Evaluation; Expenditure; Family; Funding; Geriatrics; Goals; Growth; Health; Health Benefit; Health Personnel; Health Services; Health system; Healthcare; Healthcare Market; Home; Home Care Services; Home Health Agency; Individual; Institution; Institutionalization; International; Investments; Knowledge; Life; Literature; Long-Term Care; Marketing; Measures; Medicaid; Mentors; Mentorship; Methods; Modeling; Natural Language Processing; Nursing Homes; Outcome; Patients; Pattern; Performance; Play; Policy Maker; Preparation; Primary Care; Research; Research Personnel; Risk; Risk Adjustment; Role; Self Care; Services; Structure; System; Testing; Text; Time; Training; Veterans; acute care; care costs; care systems; career development; caregiving; causal model; community based service; community setting; connected care; cost; evidence base; feasibility testing; functional status; health care quality; health care service utilization; high risk; human old age (65+); improved; informal care; informal caregiver; informal support; innovation; meetings; operation; predictive modeling; programs; prospective; skills; statistics; structured data; success; tool

By 2023, it is expected that the number of VHA enrollees aged 65 and over will increase from 4.1 million to 4.7 million. To meet the growing demand for long-term care services, VA has attempted to expand its home and community-based services (HCBS) through measures such as the 1999 Millennium Health Care and Benefits Act (the Millennium Act). These expansion efforts were based on the premise that HCBS provide care in Veterans’ setting of choice for a lower cost than in institutional settings and with comparable outcomes. Since passing the Millennium Act, however, VA still lags significantly behind other health systems with respect to rebalancing its long-term care expenditures away from institutional care and towards HCBS. VA’s 21 percentage point increase in the proportion of its long-term care expenditures spent on HCBS between 1999 and 2016 (from 5% to 26%) can be compared to Medicaid’s 42 percentage point increase over the same period (from 15% o 57%). VA needs to examine the empirical evidence to understand why this transformation remains elusive. A health system’s ability to rebalance towards HCBS is determined by a combination of patient, system, and family level factors. Precise patient targeting, local home health market conditions, and adequate supply of and support for informal caregivers all contribute to how successful health systems will be in rebalancing towards HCBS. However, these factors remain under-explored in the VA context – in part due to gaps in VA’s structured data and in part due to the limited application of methods that enable these types of analyses. My long-term goal is to become an independent investigator focused on leading research initiatives that help VA to achieve its long-term care rebalancing aims and to fill these gaps in the existing evidence base. The proposed research will strengthen VA’s knowledge of how patient, system, and family level factors are affecting its rebalancing efforts. Specifically, the research aims of this CDA-2 are to: 1) use natural language processing to extract patient functional status from free-text notes and use the constructed measures to improve prediction of Veterans’ one-year risk of institutionalization; 2) build a geospatial database of VA and VA-contracted home health providers and conduct analyses evaluating the association between distance to and market supply of home health agencies and long-term care utilization patterns; and 3) quantify the impact of informal care receipt on VA health care utilization and costs. I will achieve these aims by receiving mentorship and training in natural language processing, risk adjustment, geospatial econometrics, and causal modeling. These new skills will contribute to my overall career development and, in collaboration with my mentors and operational partners, enable me to submit two merit review proposals focused on developing enhanced HCBS patient targeting tools and improved caregivers supports. They will also enable me to submit an application for a partnered evaluation initiative with the Office of Connected Care aimed at developing a geospatial tool to help regional offices efficiently identify prospective partners for new home health service contracts. Overall, this CDA will help me to become an independent investigator focused on leading research initiatives that help VA achieve its long-term care rebalancing aims. The results of this CDA project will be relevant to Veterans, their caregivers, and VA policy makers involved in allocating long-term care funding and will be an innovative contribution to the broader literature on the determinants of successful HCBS expansion strategies.

到2023年，预计65岁及65岁及以上的VHA人数将从410万增加到4.7 百万。为了满足对长期护理服务不断增长的需求，弗吉尼亚州试图扩大其房屋和 通过1999年千年医疗保健和福利等措施，基于社区的服务（HCB） 法案（《千年法》）。这些扩展工作是基于HCB提供护理的前提 退伍军人的首选设置的成本低于机构环境和可比的结果。自从 但是，通过《千禧法》，VA仍然显着落后于其他卫生系统 将其长期护理支出从机构护理和HCB转移到HCB。 VA的21 1999年之间，其长期护理支出的比例增加了其长期护理支出的比例 2016年（从5％到26％）可以将同期医疗补助的42个百分点增加 （从15％O 57％）。 VA需要检查经验证据，以了解为什么这种转变 仍然难以捉摸。 卫生系统对HCB的重新平衡能力取决于患者，系统和 家庭水平因素。精确的患者靶向，当地的家庭健康市场状况以及足够的供应 对非正式护理人员的支持都为卫生系统重新平衡如何成功 HCBS。但是，这些因素在VA环境中仍未探索 - 部分原因是VA的差距 结构化数据，部分是由于实现这些类型分析的方法的应用有限。我的 长期目标是成为一名专注于领导研究计划的独立研究者，以帮助VA 实现其长期护理重新平衡目标，并在现有证据基础中填补这些空白。 拟议的研究将加强VA对患者，系统和家庭级别因素的了解 影响其重新平衡的努力。具体而言，该CDA-2的研究目的是：1）使用自然语言 处理以从自由文本注释中提取患者功能状态，并使用构造的措施 改善对退伍军人一年制度化风险的预测； 2）构建VA的地理空间数据库 VA收缩的家庭健康提供者并进行分析，以评估与 家庭健康机构的市场供应和长期护理利用模式； 3）量化 VA医疗保健利用和成本的非正式护理收据。我将通过获得Mentalship来实现这些目标 以及自然语言处理，风险调整，地理空间经济学和因果建模的培训。 这些新技能将有助于我的整体职业发展，并与我的导师合作 运营合作伙伴，使我能够提交两项侧重于开发增强HCB的优点审查提案 患者定位工具和改善护理人员的支持。他们还将使我提交申请 与互联护理办公室的合作评估计划旨在开发一种地理空间工具来帮助 区域办事处有效地确定了新的家庭卫生服务合同的潜在合作伙伴。 总体而言，该CDA将帮助我成为一名专注于领先研究计划的独立调查员 这有助于VA实现其长期护理重新平衡目标。该CDA项目的结果将与 退伍军人，他们的照顾者和VA政策制定者参与分配长期护理资金，将是一个 关于成功的HCB扩展策略的更广泛文献的创新贡献。

项目成果

Long-term care service mix in the Veterans Health Administration after home care expansion.

家庭护理扩展后，退伍军人健康管理局的长期护理服务组合。

• DOI: 10.1111/1475-6773.13687
• 发表时间: 2021
• 期刊: Health services research
• 影响因子: 3.4
• 作者: Jacobs,JosephineC;Wagner,ToddH;Trivedi,Ranak;Lorenz,Karl;VanHoutven,CourtneyH
• 通讯作者: VanHoutven,CourtneyH