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BACKGROUND/RATIONALE:
Long-term care (LTC) can be defined as the range of institutional and home and community-based services that support individuals needing chronic care. VA faces an increasing demand for these services with the number of veterans 85 and older, those most in need of LTC. At present, the system is unbalanced, with approximately 90% of the 2.6 billion total VA LTC dollars being spent on institutional care. VA has as a goal to increase the census in home and community-based services by 18% per year until the year 2013.
Findings from our current study indicate that the referral process is frequently unstandardized, inefficient, and not supportive of referrals to home and community-based services. The IIR Solicitation on Long Term Care calls for studies to evaluate the structure, process, and outcomes of innovative approaches to care coordination. A promising model of care coordination implemented in some VAMCs is a Single Point of Entry-Team model, in which all LTC referrals are processed by a single interdisciplinary committee. Measures of the outcomes of interest in evaluating such a model are available, with the exception of two important outcomes, satisfaction with the referral and its process and cost.
OBJECTIVE(S):
We propose a 2.5 year study to establish methods for a future study comparing the outcomes of referral models.
Objective 1) Develop and test measures of patient/caregiver and provider satisfaction,
Objective 2) Develop and test measures of process and cost of the referral models.
The long term objective of our research is to identify models of LTC referral with the best outcomes that can be implemented across VA.
METHODS:
Three VAMCs in VISN 11 - one each with a Single Point of Entry Team, individual-based referral, and mixed-model - will be the setting for this study. The Geriatrics and Extended Care Referral Form will be used to obtain samples of LTC referrals including the referred patients, their informal caregivers, referring providers, and LTC providers. Samples of 10 to 100 referrals per site will be used for the various stages of development and testing. Measures of patient/caregiver and provider satisfaction with the referral process will be developed using a multi-step procedure of item development, refinement, pilot testing, full testing, and validation, with data analysis using classical and modern test theory. Information about the process and associated cost for the selected referrals will be obtained for the same referrals. A cost function will be constructed and used to determine the minimal staff inputs necessary to accurately measure the cost of the referral process. Data on satisfaction will be collected from patients and caregivers using a computer assisted telephone interview. Data collection from providers will be combined for the satisfaction and cost sections as providers will complete questionnaires using a web query system.
FINDINGS/RESULTS:
No results as of 6/18/2008.
IMPACT:
This study will result in methods that will be used for a future study of the outcomes of alternative models of care coordination for LTC referrals. This will assist the VA in best serving the rapidly growing number of patients in need of LTC.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Health Services and Systems
DRE:
Quality of Care, Resource Use and Cost, Communication and Decision Making
Keywords:
Cost, Long-term care, Satisfaction (patient)
MeSH Terms:
none
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