TY - JOUR
T1 - National Structural Survey of Veterans Affairs Home-Based Primary Care Programs
AU - Karuza, Jurgis
AU - Gillespie, Suzanne M.
AU - Olsan, Tobie
AU - Cai, Xeuya
AU - Dang, Stuti
AU - Intrator, Orna
AU - Li, Jiejin
AU - Gao, Shan
AU - Kinosian, Bruce
AU - Edes, Thomas
N1 - Funding Information:
The authors wish to thank Dayna Cooper and Darlene Davis for their comments and the national HBPC program directors group and Deborah Peltier and the national HBPC medical directors group for their support of the survey. The authors also wish to thank Joseph Duckett for his expert assistance with REDCap and Susan Smith, Joseph Duckett, and Jill Szydlowski for their assistance in building the survey database and data verification. This work was supported by Merit Award IIR 12–152 from the VA Health Services Research and Development Program. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the VA or the U.S. government. Conflict of Interest: Karuza, Gillespie, Olsan, Cai, Intrator, Ji, Gao: no conflict of interest. Dr. Kinosian is a HBPC provider. Dr. Edes has national responsibility for HBPC. Author Contributions: Karuza, Gillespie, Olsan: Concept, design, analysis, interpretation, preparation of paper. Cai, Intrator, Ji, Gao: Analysis, interpretation. Kinosian: Concept, interpretation. Edes: Concept, interpretation, preparation of paper. Sponsor's Role: None.
Publisher Copyright:
Published 2017. This article is a U.S. Government work and is in the public domain in the USA
PY - 2017/12
Y1 - 2017/12
N2 - Objectives: To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. Design: We designed a national survey and surveyed HBPC program directors on-line using REDCap. Participants: We received 236 surveys from 394 identified HBPC sites (60% response rate). Measurements: HBPC site characteristics were quantified using closed-ended formats. Results: HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). Conclusion: HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans.
AB - Objectives: To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. Design: We designed a national survey and surveyed HBPC program directors on-line using REDCap. Participants: We received 236 surveys from 394 identified HBPC sites (60% response rate). Measurements: HBPC site characteristics were quantified using closed-ended formats. Results: HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). Conclusion: HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans.
KW - home-based primary care
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U2 - 10.1111/jgs.15126
DO - 10.1111/jgs.15126
M3 - Article
C2 - 28960236
AN - SCOPUS:85038013955
VL - 65
SP - 2697
EP - 2701
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
IS - 12
ER -