VA home-based primary care interdisciplinary team structure varies with Veterans' needs, aligns with PACE regulation.
Aged
Aged, 80 and over
Cross-Sectional Studies
Female
Frail Elderly
/ statistics & numerical data
Health Services Needs and Demand
/ statistics & numerical data
Health Services for the Aged
/ legislation & jurisprudence
Home Care Services
/ statistics & numerical data
Humans
Male
Patient Care Team
Primary Health Care
/ methods
Risk Assessment
United States
/ epidemiology
Veterans
/ statistics & numerical data
Veterans Health Services
/ legislation & jurisprudence
Veterans
frail elders
home care services
home-based primary care
patient-centered care
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
revised:
26
02
2021
received:
17
12
2020
accepted:
22
03
2021
pubmed:
10
4
2021
medline:
12
10
2021
entrez:
9
4
2021
Statut:
ppublish
Résumé
Interdisciplinary team (IDT) care is central to home-based primary care (HBPC) of frail elders. Traditionally, all HBPC disciplines managed a patient (Full IDT), a costly approach to maintain. The recent PACE (Program of All-inclusive Care for the Elderly) regulation provides for a flexible approach of annual assessments from a core team with involvement of additional disciplines dependent upon patient needs (Core+). Current Department of Veterans Affairs (VA) HBPC guidance specifies Full IDTs care for medically complex and functionally impaired Veterans similar to PACE participants. We evaluated whether VA HBPC has adopted the flexible structure of the PACE regulation, aligned to Veteran needs. Cross-sectional analysis. All 139 VA HBPC programs administered across 379 sites. About 55,173 Veterans enrolled in HBPC during fiscal year 2018. Patients' HBPC physician, nurse, psychologist/psychiatrist, social worker, therapist, dietitian, and pharmacist visits were grouped into interdisciplinary team types. Patient frailty was classified using VA HNHR v2 (High-Need High-Risk version 2, a measure of high, medium, and low risk of long-term institutionalization). Medical complexity was measured by clusters of impairment in the JEN frailty index (JFI). JFI clusters were validated by VA's Nosos measure to project cost and Care Assessment Need (CAN) measure of hospitalization and mortality risk. HBPC provided Full IDT care to 21%, Core+ care to 54%, and Home Health+ (HHA+) care (skilled home health services plus additional disciplines, without primary care) to 16% of Veterans. Team type was associated with medical complexity (X There is a strong association between HBPC team patterns and patient frailty, indicating tailoring of care to match Veteran needs.
Sections du résumé
BACKGROUND
Interdisciplinary team (IDT) care is central to home-based primary care (HBPC) of frail elders. Traditionally, all HBPC disciplines managed a patient (Full IDT), a costly approach to maintain. The recent PACE (Program of All-inclusive Care for the Elderly) regulation provides for a flexible approach of annual assessments from a core team with involvement of additional disciplines dependent upon patient needs (Core+). Current Department of Veterans Affairs (VA) HBPC guidance specifies Full IDTs care for medically complex and functionally impaired Veterans similar to PACE participants. We evaluated whether VA HBPC has adopted the flexible structure of the PACE regulation, aligned to Veteran needs.
DESIGN
Cross-sectional analysis.
SETTING
All 139 VA HBPC programs administered across 379 sites.
PARTICIPANTS
About 55,173 Veterans enrolled in HBPC during fiscal year 2018.
MEASUREMENTS
Patients' HBPC physician, nurse, psychologist/psychiatrist, social worker, therapist, dietitian, and pharmacist visits were grouped into interdisciplinary team types. Patient frailty was classified using VA HNHR v2 (High-Need High-Risk version 2, a measure of high, medium, and low risk of long-term institutionalization). Medical complexity was measured by clusters of impairment in the JEN frailty index (JFI). JFI clusters were validated by VA's Nosos measure to project cost and Care Assessment Need (CAN) measure of hospitalization and mortality risk.
RESULTS
HBPC provided Full IDT care to 21%, Core+ care to 54%, and Home Health+ (HHA+) care (skilled home health services plus additional disciplines, without primary care) to 16% of Veterans. Team type was associated with medical complexity (X
CONCLUSION
There is a strong association between HBPC team patterns and patient frailty, indicating tailoring of care to match Veteran needs.
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1729-1737Subventions
Organisme : HSRD VA
ID : IIR 16-240
Pays : United States
Informations de copyright
© Published 2021. This article is a U.S. Government work and is in the public domain in the USA.
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