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Publication Briefs

Study Shows Impact of Comprehensive Caregiver Support Program on VA Healthcare Utilization and Cost

The Program of Comprehensive Assistance for Family Caregivers (PCAFC) supports caregivers of Veterans from the post-9/11 era who need assistance with activities of daily living (ADLs) or supervision or protection because of the residual effect of injuries sustained during their service. A monthly stipend to caregivers ranges from $600-$2,300 per month depending on Veterans' care needs. Required caregiver training covers topics such as: caregiver self-care, nutrition, exercise, caregiving skills (e.g., taking vital signs, infection control), home safety, support groups, and respite. As of September 2015, more than 27,000 family caregivers were enrolled in PCAFC at a cost of over $1 billion. In this study, investigators examined the early impact of PCAFC on VA healthcare utilization and costs. The treatment group consisted of Veterans (n=15,650) whose caregivers were approved for participation in PCAFC since its inception (May 2011) through March 2014. The control group included Veterans (n=8,339) whose caregivers applied by March 31, 2014 and were not approved (most common reasons included caring for a Veteran injured before 9/11 or caring for a Veteran with non-service-related illness/injury). Study outcomes focused on VA healthcare use and total costs categorized into 6-month outcome intervals.


  • Veterans in PCAFC had similar acute care utilization when compared with those in the control group, but significantly greater primary, specialty, and mental health outpatient care use at least 30 – and up to 36 months post-application. Compared with Veterans in the control group:
    • Over time, Veterans in the PCAFC group had about a 10 percentage point higher probability of receiving any VA primary care.
    • In the first six months, Veterans in the PCAFC group had an increased probability of using any VA specialty care (75% vs. 64%). This difference persisted over time, but by 31 to 36 months was no longer statistically significant.
    • Veterans in the treatment group also had an increased probability of using mental healthcare in the first 6 months (84% vs. 77%) and this increase was sustained through 31-36 months.
  • Estimated total healthcare costs for Veterans in the PCAFC group were $1,500 to $3,400 higher per Veteran per 6-month interval than for Veterans in the control group.


  • Findings suggest that comprehensive supports for family caregivers can increase patient engagement in outpatient care in the short term, which may enhance long-term health outcomes.


  • Despite use of statistical methods to address differences across groups, it is possible that Veterans of enrolled caregivers were sicker than Veterans of caregivers not enrolled and thus used more outpatient services.
  • The analysis is more robust in the 6-month and 1-year intervals post-application due to having outcomes on nearly all applicants up to one year.

This study was partly funded by HSR&D/Quality Enhancement Research Initiative (QUERI; PEC 14-272). Dr. Van Houtven is part of HSR&D's Center for Health Services Research in Primary Care; Durham, NC.

Van Houtven C, Smith V, Stechuchak K, et al. Comprehensive Support for Family Caregivers: Impact on Veteran Health Care Utilization and Costs. Medical Care Research and Review. April 1, 2017;e-pub ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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