Evaluating the Impact of COVID-19 on Case Management, Health Care Utilization, and Housing Outcomes for HUD-VASH Veterans

评估 COVID-19 对 HUD-VASH 退伍军人的病例管理、医疗保健利用和住房结果的影响

• 批准号: 10641154
• 负责人: Eric Jutkowitz
• 金额: --
• 依托单位: PROVIDENCE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641154
• 关键词: Address; Adopted; Alcohol abuse; Ambulatory Care; Behavioral; COVID-19; COVID-19 impact; COVID-19 pandemic; Caring; Case Management; Case Manager; Clinical Services; Communities; Complex; Continuity of Patient Care; Data; Dedications; Diagnosis; Enrollment; Ensure; Evaluation; Evolution; Future; Goals; Health; Health Services Accessibility; Healthcare; Home; Homelessness; Hospitalization; Housing; Interruption; Interview; Investments; Joints; Leadership; Link; Measures; Medical; Medical center; Mental Health; Methodology; Methods; Modeling; Opioid Analgesics; Outcome; Outpatients; Persons; Pharmaceutical Preparations; Policies; Poverty; Primary Care; Provider; Risk; Series; Services; Specialist; Structure; Suicide; System; Systems Analysis; Telephone; Time; U.S. Department of Housing and Urban Development; United States Department of Veterans Affairs; Veterans; behavioral health; clinical care; data warehouse; design; evidence base; experience; follow-up; health care service utilization; implementation facilitators; improved; operation; opioid use disorder; outreach; pandemic disease; pre-pandemic; programs; public health emergency; response; secondary analysis; social health determinants; supported housing; theories; virtual; virtual healthcare

Background: The US Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program offers permanent, subsidized independent housing and case management to over 60,000 Veterans annually. In response to COVID-19, HUD-VASH shifted case management from in-person to telephone/video interactions. The goal of this project is to examine the effect of HUD-VASH’s shift to virtual care on Veteran engagement and outcomes in the program. Our proposal is motivated by a working theory that virtual care increased access to case management, primary care, and improved behavioral quality measures conducive to phone/video interactions (e.g., follow-up after a psych hospitalization), but decreased access to specialist care and worsened quality measures not conducive to phone/video interactions (e.g., meds for opioid use disorder). Significance: The VA is dedicated to improving the housing and health of Veterans. Our project will advance policy by helping the National Homeless Programs Office understand the impact of virtual care in HUD-VASH to maximize program reach, engagement, and outcomes. The project addresses VA’s FY 2018- 2024 Strategic Objective 2.2 (“VA ensures at-risk and underserved Veterans receive what they need to eliminate Veteran suicide, homelessness, and poverty”), objectives of RFA HX-21-025 (changes to virtual care on Veteran outcomes), and objectives of HSR&D (virtual care and social determinants of health). Specific Aims: Aim 1. Determine the effect of HUD-VASH’s shift to virtual care during the COVID-19 pandemic on case management services: Hypothesis: HUD-VASH’s shift to virtual care during the pandemic resulted in more total, telephone and video case management as compared to a pre-pandemic period. Secondary analysis: Identify associations between Veteran factors (e.g., mental health diagnosis) with the use of case management before and after the shift to virtual care, and Veteran factors associated with not engaging in any virtual care. Aim 2. Evaluate the effect of HUD-VASH’s shift to virtual care during the pandemic on Veteran’s health care utilization and continuity of care. Hypothesis: HUD-VASH’s shift to virtual care during the pandemic increased the use of primary care and improved some behavioral quality measures while decreased other behavioral quality measures not conducive to virtual care and the use of outpatient specialist care. Secondary analysis: Examine Veteran factors associated with HUD-VASH program exits and utilization of health care in the year after program exit. Aim 3. Examine Veteran and provider experiences with virtual case management in HUD- VASH. Semi-structured interviews with VA leadership, case managers, and Veterans who experienced HUD- VASH’s shift to virtual care, will provide an understanding of the barriers to and facilitators of the implementation of virtual case management. Methodology: A convergent parallel mixed-methods design will be used. Data from the VA’s Corporate Data Warehouse (CDW) will be linked with Homeless Operations Management and Evaluation System (HOMES) for analysis. Using these data, Aims 1 and 2 will use an interrupted time series design with segmented regression to examine utilization outcomes before and after HUD-VASH’s shift to virtual care. For Aim 3, qualitative interviews with VA leadership, case managers and Veterans will capture the experience of implementing and receiving virtual care and give context to our quantitative findings. Next Steps/ Implementation: Our findings will inform the evolution of virtual care within the HUD-VASH program. This project will also inform the Homeless Programs Office of the impact and experience of transitioning to virtual care during the pandemic and the extent this transition and pandemic disrupted VA care of homeless Veterans.

背景：美国住房和城市发展部退伍军人事务部支持性住房 (HUD-VASH) 计划为超过 每年为 60,000 名退伍军人提供应对 COVID-19 的服务，HUD-VASH 将案件管理从面对面改为面对面。 该项目的目标是检查 HUD-VASH 转向虚拟的效果。 关心退伍军人在该计划中的参与和成果。我们的提议是由一个工作理论推动的。 虚拟护理增加了获得病例管理、初级护理和改进行为质量措施的机会 有利于电话/视频互动（例如，精神病住院后的后续行动），但减少了获得信息的机会 不利于电话/视频互动的专业护理和恶化的质量措施（例如阿片类药物） 意义：VA 致力于改善退伍军人的住房和健康。 将通过帮助国家无家可归者计划办公室了解虚拟护理的影响来推进政策 HUD-VASH 旨在最大限度地扩大计划范围、参与度和成果 该项目致力于 VA 2018 财年的目标。 2024 年战略目标 2.2（“VA 确保面临风险和服务不足的退伍军人获得他们所需的 退伍军人自杀、无家可归和贫困”），RFA HX-21-025 的目标（虚拟护理的变化） 退伍军人成果）以及 HSR&D 的目标（虚拟护理和健康的社会决定因素）。 目标： 目标 1. 确定在 COVID-19 大流行期间 HUD-VASH 转向虚拟护理对病例的影响 管理服务：假设：HUD-VASH 在大流行期间转向虚拟护理导致更多 与大流行前时期相比的电话和视频案件管理总数二次分析： 使用案例管理来确定退伍军人因素（例如心理健康诊断）之间的关联 转向虚拟护理之前和之后，以及与不参与任何虚拟护理相关的退伍军人因素。 目标 2. 评估大流行期间 HUD-VASH 转向虚拟护理对退伍军人医疗保健的影响 假设：大流行期间 HUD-VASH 向虚拟护理的转变有所增加。 使用初级保健并改善一些行为质量措施，同时减少其他行为质量措施 质量措施不利于虚拟护理和门诊专科护理的使用。 检查当年与 HUD-VASH 计划退出和医疗保健利用相关的退伍军人因素 目标 3. 检查退伍军人和提供者在 HUD 中进行虚拟案例管理的经验。 VASH。对 VA 领导层、案例经理和经历过 HUD 的退伍军人进行半结构化访谈 VASH 向虚拟护理的转变将让人们了解虚拟护理的障碍和促进因素 虚拟案例管理方法的实施：融合并行混合方法设计。 来自 VA 企业数据仓库 (CDW) 的数据将与无家可归者行动部门联系起来。 目标 1 和 2 将使用管理和评估系统 (HOMES) 进行分析。 通过分段回归进行中断时间序列设计，以检查之前和之后的利用率结果 HUD-VASH 向虚拟护理的转变 对于目标 3，对 VA 领导层、个案经理和人员进行定性访谈。 退伍军人将获得实施和接受虚拟护理的经验，并为我们提供背景信息 下一步/实施：我们的研究结果将为虚拟护理的发展提供信息。 HUD-VASH 计划还将向无家可归者计划办公室通报影响和情况。 大流行期间向虚拟护理过渡的经验以及这种过渡和大流行的程度 扰乱了退伍军人管理局对无家可归退伍军人的照顾。