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2019 HSR&D/QUERI National Conference Abstract

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1076 — Veteran-Directed Care and Other Purchased Care Service Recipients Have Similar Cost and Hospitalization Trajectories

Lead/Presenter: Yingzhe Yuan,  PEPReC
All Authors: Yuan Y (PEPReC, Boston VA Healthcare System; Boston University, School of Public Health), Thomas KS (Providence VA Medical Center; Brown University, School of Public Health), Frakt AB (PEPReC, Boston VA Healthcare System; Boston University, School of Public Health) Pizer SD (PEPReC, Boston VA Healthcare System; Boston University, School of Public Health) Garrido MM (PEPReC, Boston VA Healthcare System; Boston University, School of Public Health)

Objectives:
The Veteran-Directed Care (VDC) program supports unpaid family caregivers and adults with multiple chronic conditions. Veterans with functional or cognitive limitations receive monthly budgets to purchase services that allow them to remain safely in their homes. We describe Veterans enrolled in VDC and investigate differences in hospital admissions and costs after initial receipt of VDC.

Methods:
We compared characteristics of Veterans receiving VDC and other purchased care services (homemaker/home health aide, home respite, and contract adult day healthcare). We used difference in difference-in-differences models to explore the relationship between VDC and changes in any or ambulatory care sensitive hospital admissions and costs over time. We re-ran analyses on a matched cohort of patients with similar healthcare needs and sociodemographic characteristics and examined the robustness of our results to definition of follow-up period and sample selection criteria. Our sample included 37,407 Veterans [VDC group (n = 965); Comparison group at active sites (n = 21,117); Comparison group at inactive sites (n = 15,325)] receiving VHA purchased care service in FY17.

Results:
Veterans receiving VDC were younger but had greater chronic disease indicators of burden and more functional limitations than Veterans receiving other purchased care services. Receipt of VDC was not significantly associated with a decrease in hospital admissions over time, relative to Veterans in comparison groups (OR = 0.83, 95% CI = 0.68, 1.02). VDC receipt was also not significantly related to changes in hospital costs over time (average incremental effect = -$1,753, 95% CI = -$7251, $3,746). We obtained similar results over a variety of model specifications, within matched samples, and with different definitions of the post period.

Implications:
Veterans enrolled in VDC had greater care needs and more functional limitations than Veterans receiving other purchased care services but experienced similar decreases in hospital use and costs from pre- to post-enrollment in services.

Impacts:
Given its popularity among Veterans and caregivers, VDC is a valuable model for supporting individuals with multiple chronic conditions. To allocate resources more efficiently, future work should identify the optimal target population for VDC, and the optimal methods for using the stipend to facilitate independent community living and support caregivers.