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Am J Manag Care. 2022 Aug 1;28(8):e289-e295. doi: 10.37765/ajmc.2022.89202.
The Department of Veterans Affairs (VA) Program of Comprehensive Assistance for Family Caregivers (PCAFC) is a clinical program providing training, a monthly stipend, and other services to caregivers of qualifying post-9/11 veterans with service-related injuries. Veteran-caregiver discharge from the program occurs when veteran recovery is achieved, participation is no longer in the veteran's best interest, or caregiving ceases. Public scrutiny about potentially inappropriate discharges resulted in a nationwide freeze on all discharges. PCAFC expanded to pre-9/11 veterans in October 2020; thus, lessons learned can continue to inform the expanded program. We pursued 3 objectives: (1) describe the discharge rate, reasons for discharge, and veteran and caregiver characteristics by discharge status; (2) identify factors associated with discharge from PCAFC nationally; and (3) characterize network variation in discharge predictors.
Retrospective observational study using VA administrative data from fiscal year (FY) 2011 to FY 2017.
Using multivariable Cox proportional hazards regression, we examined factors associated with PCAFC discharge among veterans and caregivers enrolled in PCAFC during FY 2011 to FY 2016.
A total of 40.5% of all participants were discharged. Nonspouse caregivers and those applying in later years had the highest rates of discharge; spouse caregivers and those applying in earlier years had the lowest rates of discharge. In 4 of 18 networks, caregivers of Black veterans faced higher rates of discharge compared with caregivers of White veterans, and in 1 network, they faced lower rates of discharge. Substantial variability in rates of discharge was also observed across Veterans Integrated Service Networks.
Training on clinically appropriate discharge criteria could improve practice and increase equity.
退伍军人事务部（VA）综合家庭护理员援助计划（PCAFC）是一个临床项目，为符合条件的 9/11 后因与服务相关的受伤而接受治疗的退伍军人的护理人员提供培训、每月津贴和其他服务。当退伍军人康复、参与不再符合退伍军人的最佳利益或护理结束时，退伍军人-护理员将从该计划中出院。公众对潜在不当出院的审查导致全国范围内暂停所有出院。PCAFC 于 2020 年 10 月扩大到 9/11 前的退伍军人；因此，吸取的经验教训可以继续为扩大后的项目提供信息。我们追求了 3 个目标：（1）按出院情况描述出院率、出院原因和退伍军人及护理人员特征；（2）确定全国范围内 PCAFC 出院的相关因素；（3）描述出院预测因素的网络差异。
使用退伍军人事务部行政数据，对 2011 财年至 2017 财年进行回顾性观察性研究。
使用多变量 Cox 比例风险回归，我们研究了在 2011 财年至 2016 财年期间参加 PCAFC 的退伍军人和护理人员中与 PCAFC 出院相关的因素。
共有 40.5%的参与者出院。非配偶护理人员和较晚申请的人员的出院率最高；配偶护理人员和较早申请的人员的出院率最低。在 18 个网络中的 4 个网络中，与白人退伍军人的护理人员相比，黑人退伍军人的护理人员面临更高的出院率，而在 1 个网络中，他们面临的出院率更低。退伍军人综合服务网络之间的出院率也存在很大差异。
关于临床适当出院标准的培训可以改善实践并提高公平性。
