The Veterans Health Administration is facing increasing numbers of older Veterans suffering from multiple chronic conditions, who are frequently hospitalized for ambulatory care sensitive conditions (ACSC) at high cost. While many efforts to redesign outpatient care for this vulnerable group have failed to reduce health care utilization, VA Home-Based Primary Care (HBPC) has recently been demonstrated to reduce rates of hospitalization for ACSCs by 27%. However there is substantial variation in HBPC implementation across sites, and the key mechanisms that drive reduced hospitalizations are unknown.
The purpose of this research is to explore what features of HBPC drive its success in reducing hospitalizations for ambulatory care sensitive conditions, and use these insights to develop an intervention to promote best practices in HBPC. The aims of this proposal are 1) Characterize patterns of enrollment and care delivery within HBPC, and determine clinical and systems correlates of preventable hospitalizations, 2) Assess HBPC provider perceptions of appropriate patient selection and care delivery patterns, core functions of HBPC, and barriers and facilitators to HBPC performance, and 3) Develop and test a pilot intervention to promote best practices in HBPC
Aim 1 is a quantitative study consisting of four secondary analyses of national VHA data to (1) determine predictors of enrollment in HBPC, (2) define clinical subgroups of HBPC patients, (3) describe care delivery patterns within HBPC, and (4) determine association of patient subgroups and care delivery patterns with ambulatory care sensitive hospitalizations. Aim 2 is a two phase qualitative study. The first phase is an in depth study of the Portland HBPC program using interviews, focus groups and structured observation. In the second phase, program directors at other HBPC sites will be to gain an understanding of differences across sites. Finally, Aim 3 will be the development of a pilot intervention to promote best practices in HBPC learned from Aims 1 and 2, which will be tested locally in a trial.
Not yet available.
The research has the potential to improve the quality and efficiency of the HBPC program nationally, leading to improved care for older medically complex Veterans, and reduced rates of hospitalization and long term institutionalization.
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