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2019 HSR&D/QUERI National Conference Abstract

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1109 — Strategies Used by Home-Based Primary Care Teams to Support Veterans at Home

Lead/Presenter: Leah Haverhals,  COIN - Seattle/Denver
All Authors: Haverhals LM (Seattle/Denver Center of Innovation, VA Eastern Colorado Health Care System), Manheim C (Seattle/Denver Center of Innovation, VA Eastern Colorado Health Care System), Gilman C (Seattle/Denver Center of Innovation, VA Eastern Colorado Health Care System) Karuza J (Canandaigua VA Medical Center, Division of Geriatrics/Aging; Department of Medicine, University of Rochester School of Medicine; Department of Psychology, S.U.N.Y at Buffalo State) Olsan T (Canandaigua VA Medical Center, School of Nursing, University of Rochester, Rochester) Edwards ST (Section of General Internal Medicine, VA Portland Health Care System; Division of General Internal Medicine and Geriatrics, Oregon Health and Science University) Levy CR (Seattle/Denver Center of Innovation, VA Eastern Colorado Health Care System; University of Colorado, Anschutz Medical Campus, School of Medicine, Department of Medicine, Division of Health Care Policy and Research) Gillespie SM (Canandaigua VA Medical Center, Division of Geriatrics/Aging; Department of Medicine, University of Rochester School of Medicine)

Objectives:
U.S. Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) Program provides interdisciplinary, long-term primary care for frail, disabled, or chronically ill Veterans. This research describes strategies used by HBPC teams to support Veterans in their homes, rather than in institutionalized care.

Methods:
In-person site visits were conducted at 8 HBPC programs from Sept 2017-March 2018. Site selection criteria included low hospitalization rates and completion of initial surveys. Sites varied in location, setting, and primary care model. Focus groups and semi-structured interviews were conducted with HBPC program directors, medical directors, team members, and key staff (N = 105). Field observations included HBPC visits to Veterans' homes and team meetings.

Results:
Qualitative thematic content analysis revealed four main strategies drive and support the shared mission of HBPC teams to support Veterans at home: open communication, developing relationships, education, and collaboration. Effective and open team communication was non-hierarchical, formal and informal. Communication between team members and Veterans/caregivers was frequent and clear, both during home visits and by phone. Team relationships were strengthened by shared commitment to Veterans and a dedication to team cohesiveness. In turn, relationships with Veterans/caregivers were built on continuity of care, reliability, and trust. Team education and education for Veterans/Caregivers was ongoing and person-centered. Educational efforts related to goals of care, advanced care planning, and strategies for acute illness management. Across professions collaboration was highly valued and centered on respect, trust, dedication to Veterans' care, and proved essential to providing Veterans' quality care.

Implications:
Four primary strategies were used by HBPC teams to keep Veterans at home: open communication, fostering strong relationships, targeted education, and team collaboration. These strategies comprised the core values for HBPC teams, who displayed pride and dedication to their mission of caring for medically complex HBPC Veterans.

Impacts:
Focusing on the strategies identified in this research may be useful to achieve similar positive outcomes with medically complex, homebound patients both within and outside VA.