Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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2003 — Veteran Directed Home and Community Based Services Evaluation: Collaboration for a Common Mission

Lead/Presenter: James Rudolph, COIN - Providence
All Authors: Garrido MM (Partnered Evidence-Based Policy Resource Center) Thomas KS (LTSS COIN Providence VAMC) Sperber NR (COIN Durham VAMC) Esmurdoc FC (Office of Geriatrics and Extended Care)

Brief description of panelists:
Moderator: James Rudolph, MD LTSS-COIN Director, Providence VAMC Lead Author: Melissa Garrido, PhD, Partnered Evidence-Based Policy Resource Center (PEPReC) Operations Partner: F. Chris Esmurdoc, Program Manager of Purchased Care, Office of GEC Operation Randomization and Outcomes Analyses: Veteran and Caregiver Experience Analysis: Kali Thomas, PhD, Co-PI Providence VAMC Implementation Analysis: Nina Sperber, PhD, Co-PI COIN Durham VAMC

Description of the question or issue that will be discussed:
The VA Office of Geriatric and Extended Care (GEC) partners with the US Department of Health and Human Services Administration for Community Living (ACL) to offer Veterans at risk of nursing home placement an opportunity to purchase home-based medical services or equipment through the Veteran Directed Home and Community Based Services (VD-HCBS) Program. VD-HCBS is associated with improved Veterans' satisfaction, flexibility, and choice in services. Beginning in March 2017, GEC and ACL are randomly staggering expansion of VD-HCBS to the 77 VA medical centers yet to implement the program over the next 3 years. This stepped wedge roll-out will facilitate rigorous evaluation of VD-HCBS' impact on Veterans' health care use while allowing program implementation to occur in a practicable manner. In addition, HSRandD investigators are conducting a multi-level wrap-around evaluation of the program's impact on Veterans' and caregivers' well-being and local experiences with implementation and VA-community agency interaction. Panelists will discuss methods for 1) using a stepped wedge and wrap-around approach to evaluate implementation and impact in real-world settings and 2) collaboration between different VA entities (operations and research) and non-VA partners to offer community-based care to older and disabled Veterans.

Significance—Description of why the issue is important for Veterans, VA, and the audience:
The VD-HCBS expansion is an opportunity to preserve Veteran independence in the community. Evaluation of this expansion will provide concrete information on outcomes for different stakeholders (Veterans, caregivers, health system) and best practices for large-scale program dissemination. Findings will provide insights to ensure that community-based, self-directed long-term services and supports programs effectively facilitate independence for Veterans and their aging and disabled civilian counterparts. Panelists will share lessons learned from their experience designing and kicking off a stepped-wedge evaluation with VA researchers, VA operations stakeholders, and community stakeholders.