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 大流行扰乱了患有慢性病的退伍军人的门诊医疗保健 条件，包括那些最需要 VA 护理的人。 意义/影响：本研究将研究 VA 医疗保健系统在提供服务方面的关键作用 疫情期间的慢性病管理，包括办公室、视频和电话护理，并评估 因慢性病恶化住院风险最高的老年退伍军人的临床结果 此外，我们将探讨 VA 老年延伸护理院和社区如何- 基于服务 (HCBS) 缓解了与 Covid-19 相关的医疗保健中断。 创新：这项研究将采用最新的分析工具来研究老年人的健康结果 退伍军人，衡量 VA HCBS 计划获得情况的方法，并确定那些面临最高风险的人 并延迟慢性病护理。 具体目标：使用最先进的方法，我们将实现以下目标： 目标 1A：检查门诊护理中断对慢性病管理的影响 (CCM) 对于老年退伍军人，我们将确定门诊护理随时间的变化（“中断”），包括 门诊初级和门诊提供的面对面和虚拟就诊、视频和电话的数量 我们将研究大约 100 万老年（年龄≥65 岁）退伍军人，其中至少有 3 种慢性病。 医疗和老年疾病：高血压、充血性心力衰竭 (CHF) 或跌倒/行动障碍 在 Covid-19 危机期间（2020-21 年），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的脆弱性将受到影响。 使用 VA 患者的既定方法和另外两种专门针对 VA 患者开发的方法来定义 老年患者群体，预测长期住院 (PLI) 措施 接下来，在目标 1B 中，我们。 将测试能够更好地获取 HBCS 的设施是否减轻了 这一关键目标将扰乱门诊护理对慢性病护理管理绩效的影响。 重点关注 5 个 HBCS 计划：家庭初级护理、个人护理服务（家庭主妇和家庭护理） 健康助手、暂托护理）、退伍军人指导护理、成人日托和熟练家庭护理（例如身体和护理） 职业治疗、护理、社会工作） 目标 2：检查慢性病管理中断对 ACSC 住院治疗的影响 我们将确定老年退伍军人在最初的护理期间是否受到较少的干扰。 第二次 Covid-19 激增也降低了与 ACSC 相关的慢性住院的住院风险 与慢性心力衰竭和高血压有关或与跌倒相关的伤害有关。此目标将有助于更好地了解 如何根据脆弱性预测老年退伍军人中 ACSC 的住院情况。 方法：这是一项针对国家 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 长期护理数据以及 VA 和 VA 的药房文件合并 我们将与 GEC 数据分析中心合作使用风险评分和数据源。 后续步骤：我们将确定应优先为老年人提供的慢性病管理服务 退伍军人以及未来 VA 门诊护理和 GEC 医疗保健系统如何实现的潜在路线图 合作伙伴为老年退伍军人提供更好的慢性病管理并获得更好的健康结果。