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Intrator O, Cai S, Gidmark S, Meucci M, Kinosian B, Phibbs C, Massey K, Shay K. The Geriatrics and Extended Care Data and Analyses Center: evaluation of the VHA Office of Geriatrics and Extended Care’s transformational pilot projects. Paper presented at: AcademyHealth Annual Research Meeting; 2013 Jun 24; Baltimore, MD.
Research Objective: The Veterans Health Administration(VHA) is committed to transforming itself into a 21st-century health care organization that embodies patient centered care. In 2010, the VHA launched an initiative to implement innovations in services that enhance VHA's capabilities to provide patient centered alternatives to long term institutional care. Through a competitive Request for Proposal (RFP) process, the Office of Geriatrics and Extended Care (GEC) awarded funding to initiate 59 innovative pilots of patient centered non-institutional extended care and to augment the Veteran-Directed Home and Community- Based Care program. These translational programs were designed to improve patient care, but no formal evaluation measures were mandated prior to funding. The Geriatrics and Extended Care Data and Analyses Center (GEC DAC) was formed in early 2012, and has been charged with conducting in-depth evaluations of these programs in order to understand the quality of care and costs related to these programs, as well as identify any limitations in the programs to improve future rounds of funded transformational programs. Study Design: The business plans from 7 GEC translational programs that focused on either Geriatric Primary Care (GPC) or Transitional Care (TC) were identified. GEC DAC worked with each program director to define all expected outcomes of the program and identify a comparison group. Each program was then individually evaluated using VHA claims data (January 2008 - March 2012). Population Studied: All Veterans enrolled in 7 different transformational programs (4 GPC programs and 3TC programs) across the country (N = 1223). Principal Findings: Of the 7 programs evaluated, 3 programs (1 GPC program and 2 TC programs) had comparison groups, either from wait-lists or refusals or from an associated site that did not receive the intervention. The GPC programs with a comparison group showed that in the second half of the year following the intervention, program enrollees had 0.53 times as many ER visits, and were 48% less likely to have an inpatient stay than the comparison cohort. The reduced utilization resulted in a lower average cost per person in the program enrollees following the intervention, although this difference was not statistically significant. In both of the transitional care groups, the re-hospitalization rates were lower in the intervention group, although not statistically significantly different than the comparisons. For the 4 programs without a comparison group, it was difficult to determine whether changes in health care utilizations from before to after intervention were due to the program effects or other factors such as aging and/or deteriorating health conditions. Conclusion: Evaluation of the translational programs provides important feedback to programs. Evaluations would be strengthened by having comparison groups identified prior to program initiation. Implications for Policy, Delivery or Practice: In order to improve comparison GEC DAC has developed a short assessment instrument that provides information on physical and cognitive status of Veterans, which it is beginning to roll out to new T21 programs as well as to other VA programs. A standardized assessment of function in this population is important and can ultimately assist GEC operations as well as long-term planning and policy.
