Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
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.
J Am Med Dir Assoc. 2021 May;22(5):1043-1051.e1. doi: 10.1016/j.jamda.2020.12.033. Epub 2021 Jan 29.
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).
Retrospective claims-based study.
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).
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.
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.
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.
本研究旨在探讨项目现场和退伍军人特征与退伍军人事务部（VA）家庭为基础的初级保健（HBPC）中接受治疗的退伍军人的潜在可避免住院或其他住院的关联程度。
回顾性基于索赔的研究。
研究了在 2016 财年（FY）对 HBPC 计划全国调查做出回应的 HBPC 计划（n=189）。分析队列中的退伍军人被确定为在 FY2016 中已登记参加 VA-HBPC，但在 FY2016 首次 HBPC 登记前的 1 年内未接受 VA-HBPC 护理的退伍军人（n=8497）。
使用六类结果的多变量逻辑回归分析，这些结果在首次 HBPC 登记日期后的 6 个月内：（1）根据 AHRQ 预防质量指标（PQI）确定的任何有潜在可避免的门诊护理敏感条件（ACSC）的住院治疗，（2）任何其他非 ACSC 条件的住院治疗，（3）在研究期间死亡，（4）从 HBPC 出院，或（5）继续在家中接受 HBPC。为每个结果类别报告退伍军人层面和 VA-HBPC 层面协变量的平均边缘效应（AME）。
更脆弱的退伍军人和 85 岁或以上的退伍军人更有可能发生潜在可预防的 ACSC 住院治疗（AME=5.4%，1.8%）。年龄小于 75 岁、功能受损、卧床不起或脆弱的退伍军人更有可能发生非 ACSC 住院治疗（AME=3.0%，2.2%，3.5%和 9.0%）。脆弱指数评分较低的退伍军人不太可能发生非 ACSC 住院治疗（AME=-17.1%）。六个月的住院治疗模式与报告的 HBPC 站点特征无关。
在全国 VA HBPC 计划的框架内，HBPC 站点使用的结构模型的差异与住院治疗没有显著关联。基于个体患者因素和临床判断而不是标准协议来调整 HBPC 护理，可能是 HBPC 成功减少 ACSC 住院治疗的关键。
