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Evaluation of Veteran-Directed Home and Community Based Services (VD-HCBS Eval)

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ClinicalTrials.gov Identifier: NCT03145818
Recruitment Status : Active, not recruiting
First Posted : May 9, 2017
Last Update Posted : June 28, 2019
Sponsor:
Collaborators:
VHA Geriatrics and Extended Care
US Department of Health and Human Services Administration for Community Living
VHA Partnered Evidence-Based Policy Resource Center
Information provided by (Responsible Party):
VA Office of Research and Development

Brief Summary:
Veteran-Directed Home and Community Based Services (VD-HCBS) is focused on preserving Veteran's independence and the VA Office of Geriatrics and Extended Care is planning an expansion of VD-HCBS to 90 additional VA Medical Centers over the next 3 years. This proposal seeks to evaluate the VD-HCBS expansion to capture comprehensive information on the impact of VD-HCBS on Veterans' and Caregivers' outcomes, as well as, to identify how the program was implemented.

Condition or disease Intervention/treatment
Functional Impairment Caregiving Other: VD-HCBS

Detailed Description:
In the next decade, there will be a doubling of older Veterans for whom the VA has a requirement to provide long-term care. At a cost of $110,000 per year for long-term care, Geriatrics and Extended Care (GEC) is seeking to preserve Veteran independence in the community. VD-HCBS is a person-centered consumer-directed program that provides Veterans the opportunity to self-direct their long-term services and supports (LTSS) and continue to live independently at home. GEC is planning to expand VD-HCBS to an additional 90 VAMCs over the next 3 years. This proposal will provide important outcomes and context to the VD-HCBS expansion. The specific aims of this proposal are: Aim 1: To describe the impact of VD-HCBS on Veterans' satisfaction, unmet need for services, quality of life and independence using mixed methods. Aim 1 will utilize operations data to describe the change in Veteran-reported satisfaction, unmet needs, and independence from enrollment in VD-HCBS to 3 and 12 months. Additionally, the investigators will conduct interviews with Veterans to capture their experiences with the program. Aim 2: To understand the effect of VD-HCBS on Caregivers' well-being. Aim 2 will compare Caregivers' financial strain, depressive symptoms, caregiving stress, and health status and positive caregiver experiences to a propensity matched population from existing VA data to determine the impact of the VD-HCBS program on Caregivers. Aim 3: To examine the implementation of the VD-HCBS program expansion. Aim 3 will utilize the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change to interview coordinators, and other key informants, from VA and ADNA VD-HCBS pairs. The analysis will shed light on how contextual factors and implementation strategies relate to implementation and Veteran outcomes. VD-HCBS has tremendous opportunity to improve the fiscal outlook of GEC's LTSS while delivering the highest level of Veteran-centered care. In concert with the outcomes of VD-HCBS, this implementation evaluation will be critical to determining how the VA system, in partnership with community-based organizations, implements programs and illuminating important leverage points to facilitate implementation effectiveness. With the diverse team assembled and the comprehensive evaluation proposed, the investigators will produce evidence to inform VA program implementation and dissemination, a critical component of the VA's priorities to develop high-performing, highly-reliable, and consistent networks.

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Study Type : Observational
Estimated Enrollment : 1500 participants
Observational Model: Other
Time Perspective: Prospective
Official Title: Evaluation of Veteran Directed Home and Community Based Services
Actual Study Start Date : May 8, 2017
Estimated Primary Completion Date : September 30, 2019
Estimated Study Completion Date : September 30, 2020

Group/Cohort Intervention/treatment
Veterans
Veterans will be the primary group for whom the VD-HCBS Program is implemented. Veterans enrolled in VD-HCBS will be functionally impaired
Other: VD-HCBS
Like the participant-directed programs developed for Medicaid programs,VD-HCBS maximizes Veteran-centered care and independence. VD-HCBS provides Veterans with a monthly financial allotment based on an assessment of the extent of their need for assistance with personal care due to injury or the impact of disease

Caregivers
Caregivers support Veterans independence in their home and community
Other: VD-HCBS
Like the participant-directed programs developed for Medicaid programs,VD-HCBS maximizes Veteran-centered care and independence. VD-HCBS provides Veterans with a monthly financial allotment based on an assessment of the extent of their need for assistance with personal care due to injury or the impact of disease

VHA Coordinators
VHA VD-HCBS Coordinators allow the program to operate within the VA
Other: VD-HCBS
Like the participant-directed programs developed for Medicaid programs,VD-HCBS maximizes Veteran-centered care and independence. VD-HCBS provides Veterans with a monthly financial allotment based on an assessment of the extent of their need for assistance with personal care due to injury or the impact of disease

ADNA Coordinators
ADNA Coordinators engage with the Veteran, Caregivers, and VA Coordinators to ensure the Veteran is able to maintain independence
Other: VD-HCBS
Like the participant-directed programs developed for Medicaid programs,VD-HCBS maximizes Veteran-centered care and independence. VD-HCBS provides Veterans with a monthly financial allotment based on an assessment of the extent of their need for assistance with personal care due to injury or the impact of disease




Primary Outcome Measures :
  1. Veteran's unmet need for services [ Time Frame: 12 months ]
    Veterans enrolled in VD-HCBS have needs for services, the primary outcome are the needs which are not currently met

  2. Caregiver well-being [ Time Frame: 9 months ]
    Caregiving wellbeing will be measured with a composite of financial strain, depressive symptoms, caregiving stress, and health status and positive caregiver experiences

  3. VHA VD-HCBS Coordinator implementation experience [ Time Frame: 9 months ]
    This semi-structured interview will identify constructs from the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change (ERIC).

  4. ADNA Coordinator implementation experience [ Time Frame: 9 months ]
    This semi-structured interview will identify constructs from the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change (ERIC).



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Veterans enrolled in VD-HCBS tend to be older with functional impairments which could precipitate facility based care placement
Criteria

Inclusion Criteria:

  • Veterans who are eligible and enrolled in VD-HCBS at the expansion VAMCs

Exclusion Criteria:

  • Non-Veterans
  • Those not eligible or enrolled in VD-HCBS
  • Enrolled in VD-HCBS at a non-expansion VAMC

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03145818


Locations
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United States, North Carolina
Durham VA Medical Center, Durham, NC
Durham, North Carolina, United States, 27705
United States, Rhode Island
Providence VA Medical Center, Providence, RI
Providence, Rhode Island, United States, 02908
Sponsors and Collaborators
VA Office of Research and Development
VHA Geriatrics and Extended Care
US Department of Health and Human Services Administration for Community Living
VHA Partnered Evidence-Based Policy Resource Center
Investigators
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Principal Investigator: James L. Rudolph, MD Providence VA Medical Center, Providence, RI

Additional Information:
Publications of Results:
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Responsible Party: VA Office of Research and Development
ClinicalTrials.gov Identifier: NCT03145818     History of Changes
Other Study ID Numbers: SDR 16-194
First Posted: May 9, 2017    Key Record Dates
Last Update Posted: June 28, 2019
Last Verified: June 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by VA Office of Research and Development:
dissemination