Suzanne M Gillespie1, Jiejin Li2, Jurgis Karuza3, Cari Levy4, Stuti Dang5, Tobie Olsan6, Bruce Kinosian7, Orna Intrator2. 1. Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA. Electronic address: suzanne.gillespie@va.gov. 2. Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; Geriatrics & Extended Care Data Analysis Center, Office of Geriatrics & Extended Care, Office of Geriatrics and Extended Care, U.S. Department of Veterans Affairs, Washington, DC, USA; Department of Public Health Sciences, University of Rochester, Rochester, NY, USA. 3. Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Department of Psychology, SUNY at Buffalo State, Buffalo, NY, USA. 4. Veterans Health Administration, ECHCS, Denver-Seattle Center of Innovation for Veterans Centric & Value Driven Care, Aurora, CO, USA; University of Colorado, Anschutz Medical Campus, School of Medicine, Department of Medicine, Division of Health Care Policy and Research, Aurora, CO, USA. 5. Miami Veterans Affairs Healthcare System, Miami, FL, USA; Miami Veterans Affairs Geriatric Research Education and Clinical Center, Miami, FL, USA; Division of Geriatrics and Palliative Care, University of Miami Miller School of Medicine, Miami, FL, USA. 6. Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; School of Nursing, University of Rochester, Rochester, NY, USA. 7. Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Cpl Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
Abstract
OBJECTIVES: This study examined the extent to which program site-based and Veteran characteristics were associated with potentially avoidable hospitalizations or other hospitalization of Veterans enrolled in the Veterans Affairs (VA) Home-Based Primary Care (HBPC). DESIGN: Retrospective claims-based study. SETTING AND PARTICIPANTS: HBPC programs that responded to a national survey of HBPC programs (n = 189) in fiscal year (FY) 2016 were studied. Veterans in the analysis cohort were identified as having been enrolled in VA-HBPC in FY2016 who had not received care by VA-HBPC within 1 year prior to their first HBPC enrollment in FY2016 (N = 8497). METHODS: Multinomial logistic regression analysis with 5 outcome categories within the 6 months following the first HBPC enrollment date: (1) any potentially avoidable hospitalizations for ambulatory care-sensitive conditions (ACSC) as identified by AHRQ Prevention Quality Indicator (PQI), (2) any other hospitalizations for non-ACSC conditions, (3) died during study period, (4) discharged from HBPC, or (5) remained at home with HBPC. Average marginal effects (AME) of veteran-level and VA-HBPC-level covariates are reported for each of the outcome categories. RESULTS: More frail Veterans and Veterans 85 years old or older were more likely to have potentially preventable ACSC hospitalizations (AME = 5.4%, 1.8%, respectively). Veterans who were younger than 75 years, functionally impaired, bed-bound, or frail were more likely to have non-ACSC hospitalization (AME = 3.0%, 2.2%, 3.5%, and 9.0%, respectively). Veterans with low frailty index scores were less likely to have non-ACSC hospitalizations (AME = -17.1%). Six-month hospitalization patterns were not associated with reported HBPC site characteristics. CONCLUSIONS AND IMPLICATIONS: Within the framework of the national VA HBPC program, variations in the structural model used at HBPC sites are not significantly associated with hospitalizations. Tailoring of HBPC care, based on individual patient factors and clinical judgment rather than standard protocols, may be central to the success of HBPC in reducing ACSC hospitalizations. Published by Elsevier Inc.
OBJECTIVES: This study examined the extent to which program site-based and Veteran characteristics were associated with potentially avoidable hospitalizations or other hospitalization of Veterans enrolled in the Veterans Affairs (VA) Home-Based Primary Care (HBPC). DESIGN: Retrospective claims-based study. SETTING AND PARTICIPANTS: HBPC programs that responded to a national survey of HBPC programs (n = 189) in fiscal year (FY) 2016 were studied. Veterans in the analysis cohort were identified as having been enrolled in VA-HBPC in FY2016 who had not received care by VA-HBPC within 1 year prior to their first HBPC enrollment in FY2016 (N = 8497). METHODS: Multinomial logistic regression analysis with 5 outcome categories within the 6 months following the first HBPC enrollment date: (1) any potentially avoidable hospitalizations for ambulatory care-sensitive conditions (ACSC) as identified by AHRQ Prevention Quality Indicator (PQI), (2) any other hospitalizations for non-ACSC conditions, (3) died during study period, (4) discharged from HBPC, or (5) remained at home with HBPC. Average marginal effects (AME) of veteran-level and VA-HBPC-level covariates are reported for each of the outcome categories. RESULTS: More frail Veterans and Veterans 85 years old or older were more likely to have potentially preventable ACSC hospitalizations (AME = 5.4%, 1.8%, respectively). Veterans who were younger than 75 years, functionally impaired, bed-bound, or frail were more likely to have non-ACSC hospitalization (AME = 3.0%, 2.2%, 3.5%, and 9.0%, respectively). Veterans with low frailty index scores were less likely to have non-ACSC hospitalizations (AME = -17.1%). Six-month hospitalization patterns were not associated with reported HBPC site characteristics. CONCLUSIONS AND IMPLICATIONS: Within the framework of the national VA HBPC program, variations in the structural model used at HBPC sites are not significantly associated with hospitalizations. Tailoring of HBPC care, based on individual patient factors and clinical judgment rather than standard protocols, may be central to the success of HBPC in reducing ACSC hospitalizations. Published by Elsevier Inc.
Authors: Mary Ersek; Anne Sales; Shimrit Keddem; Roman Ayele; Leah M Haverhals; Kate H Magid; Jennifer Kononowech; Andrew Murray; Joan G Carpenter; Mary Beth Foglia; Lucinda Potter; Jennifer McKenzie; Darlene Davis; Cari Levy Journal: Implement Sci Commun Date: 2022-07-20