Anticipated Impacts on Veterans Health Care: Hospitalization and Emergency Department (ED) visits in community hospitals represent a vulnerable time for Veterans, since dual VA-Community healthcare can be associated with adverse health outcomes. The rigorous evaluation of VA Office of Community Care (VAOCC) Acute Hospital Care Coordination Program that we propose will yield valuable formative and summative information to our operations partner. A systematic program evaluation has the potential to: expand knowledge of best practices for hospital care transitions, better understand factors associated with program effectiveness, and enable comparisons of differential impacts among rural vs. urban Veterans. Background: While current VA access initiatives should have net-positive impacts for Veterans, there may be negative unintended consequences. To address these concerns, the VAOCC is currently developing a multicomponent, evidence-based care coordination program to help Veterans receiving acute (ED and hospital) care at non-VA facilities navigate back to the VA system. Our Ralph H. Johnson VAMC team has partnered with VAOCC in developing this program, and when implemented nationally, the VAOCC Acute program will be the first in VA to address cross-system hospital care and the first national rollout in or outside VA of a post-discharge care coordination intervention. Objectives Specific Aim 1: Evaluate the implementation of the VAOCC Acute Community Hospital Care Coordination Program across multiple implementation domains including adoption of key program components, fidelity of implementation, reach to community partners and eligible Veterans, and maintenance of program activities in 3 VISNs (7, 8, 19). Evaluation will be guided by the RE-AIM model collecting formative information using VA operations data to be shared with VAOCC during program roll-out.
Specific Aim2 : Determine overall program effectiveness (summative evaluation) in coordinating care for Veterans through a) reducing subsequent acute healthcare utilization, b) fidelity to key intervention components, and c) reducing/neutralizing costs. H1: Veterans with acute community care events after program implementation will experience lower rates of a) 7-day, 30-day ED revisit, b) 7-day, 30-day hospital readmission, c) fewer total hospital days per episode of acute illness as compared to Veterans from the pre-implementation period. H2: Facilities implementing program components with higher measures of fidelity and higher satisfaction with/perception of care transition quality will demonstrate larger relative improvements in healthcare utilization and as compared to facilities with lower levels of implementation success. H3: In a formal cost benefit analysis considering program costs and estimated savings including avoided acute care visits, the program will be deemed budget neutral or cost saving based on cost-benefit ratios. Methods. Patient-reported data will be collected using interactive voice response (IVR) and telephone interviews. Qualitative interviews and questionnaire methods will be used for VA providers. For utilization outcomes, we will create a research database of merged VA (CDW) and state level all-payer claims data from 3 states (FL, SC, CO). As part of our summative evaluation, we will use a qualitative case study approach in analyzing qualitative interviews, and we will integrate findings from various data sources.
Veterans who get much of their healthcare in the VA system are often hospitalized or seen emergently at non- VA community hospitals or clinics. While this is often necessary and wanted, some research says that getting care at multiple places can result in problems like higher risk for getting re-admitted to the hospital or having medical complications. In order to make cross-system healthcare safer, the VA Office of Community Care is designing programs to coordinate Veterans? medical care during and after visits in community hospitals. Our research team plans to study these new programs when VA facilities across the country start using them in 2018. We plan to measure whether or not Veterans are more likely to get readmitted to the hospital or seen in emergency departments once the programs start, and we?ll ask Veterans, doctors, and nurses what they think about the programs. Our goal is to figure out if the programs are helpful and successful, and to improve them for the future.
