Using Home Care as a Managed Care Intervention: Findings from a VA Cooperative Study of Team Managed Hospital Based Home Care

Hughes SL, Weaver FM, Kubal JD. Using Home Care as a Managed Care Intervention: Findings from a VA Cooperative Study of Team Managed Hospital Based Home Care. Paper presented at: Gerontological Society of America Annual Scientific Meeting; 1997 Nov 14; Cincinnati, OH.

The VA team Managed Hospital Based Home Care (TM/HBHC) model emphasizes primary care management of patients in and outside of the acute care hospital. An RCT of the model found a 29% (p < .03) reduction in hospital re admission costs for severely disabled and terminally ill patients. The current study is testing the generalizability of this finding through an RCT at 16 VA hospitals. Patients with 2 or more ADLs, terminal illness, congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD) are stratified by disease and age and randomly assigned to TM/HBHC or customary care. Total health care costs are being assessed over 12 months using VA and HCFA administrative databases. Secondary outcomes of functional status, health related quality of life, satisfaction with care and caregiver burden are assessed at baseline, 1, 6, and 12 months. by 1-1-97, 1,663 patients had been enrolled, including 75% severely disabled, 20% terminal, 4% COPD, and 1% CHF. Patients had a mean age of 71, 63% are white, and 32% had an income less than $10,000. 76% had been hospitalized in the six months prior to study enrollment, indicating a very high risk of repeat admission. To date 37% have been readmitted to a VA hospital during the first 6 study months. the implications of these and of implementation findings for the field will be discussed.