VA-GRACE Program Effectively Supports Aging Veterans and Caregivers But Does Not Reduce Readmissions
The U.S. Veteran population is aging; by 2028, one-third of Veterans is expected to be 75 years of age or older. This older population often has functional impairments and high multimorbidity, thus requiring more healthcare services. The Geriatric Resources for Assessment and Care of Elders (GRACE) program is a collaborative, multidisciplinary care model that provides home-based geriatric care management. This retrospective cohort study was conducted to evaluate VA-GRACE since its implementation (2010 to 2020) in terms of its effect on mortality and readmissions – and to examine patient, caregiver, primary care provider, and VA-GRACE staff satisfaction. This study included Veterans admitted to one VA hospital (2010-2019) who received VA-GRACE services post-discharge (n=683), and Veterans who were potentially eligible for VA-GRACE but did not receive services (usual care, n=4,313). Outcomes included all-cause readmissions at 90 days and 1 year post-discharge from the index hospitalization; 90-day and 1-year mortality; and the combined endpoint of readmission or death at 90 days or 1 year. Investigators examined patients’ baseline characteristics including age, race, gender, comorbid conditions, prior healthcare use, and the index hospitalization diagnosis. Investigators also conducted interviews with several participants, caregivers, and providers.
- Veterans receiving VA-GRACE services had a much greater comorbidity burden than Veterans in usual care, indicating that the program is serving its target population: highest-risk, community-dwelling older Veterans.
- Veterans participating in VA-GRACE had higher 90-day and one-year hospital readmissions, but lower 90-day mortality rates than Veterans in usual care.
- Veterans, caregivers, and primary care providers reported very high satisfaction with the program. More specifically, Veterans and caregivers reported that VA-GRACE home visits reduced travel burden, and that the program linked them to needed resources. Primary care providers reported that the VA-GRACE team helped reduce their workload, improved medication management for their patients, and provided a view into patients’ daily living situation.
- The widespread deployment of programs like VA-GRACE will be required to support the Veteran population to age in place.
- Differences in outcomes between Veterans in VA-GRACE and Veterans in usual care may reflect, in part, unmeasured confounding.
- This evaluation included the only site within the VA healthcare system that is currently implementing the GRACE model.
This study was supported by HSR&D’s Quality Enhancement Research Initiative (QUERI). All authors are part of EXTEND QUERI. Drs. Schubert, Myers, Damush and Bravata are also part of HSR&D’s Center for Health Information and Communication (CHIC).
Schubert C, Perkins A, Myers L, Damush T, Penney L, Zhang Y, Schwartzkopf A, Preddie A, Riley S, Menen T, and Bravata D. Effectiveness of the VA-Geriatric Resources for Assessment and Care of Elders (VA-GRACE) Program: An Observational Cohort Study. Journal of the American Geriatrics Society. August 29, 2022; online ahead of print.