Fewer potentially avoidable health care events in rural veterans with self-directed care versus other personal care services.

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  • Additional Information
    • Source:
      Publisher: Blackwell Science Country of Publication: United States NLM ID: 7503062 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-5415 (Electronic) Linking ISSN: 00028614 NLM ISO Abbreviation: J Am Geriatr Soc Subsets: MEDLINE
    • Publication Information:
      Publication: Malden, MA : Blackwell Science
      Original Publication: New York [etc.]
    • Subject Terms:
    • Abstract:
      Background: Rural residents face more barriers to healthcare access, including challenges in receiving home- and community-based long-term services, compared to urban residents. Self-directed services provide flexibility and choice in care options and may be particularly well suited to help older adults with multiple chronic conditions and functional limitations who reside in rural areas remain independent and live in the community.
      Methods: We conducted a retrospective observational study to understand whether differences in health outcomes between Veteran-Directed Care (VDC), a self-directed Veterans Health Administration (VHA)-paid care program, and other VHA-paid home- and community-based personal care services vary in rural/urban location. The sample included 37,395 veterans receiving VHA-paid home- and community-based long-term care services in FY17. Our primary outcomes were changes in monthly incidence of VHA or VHA-paid community acute care admissions, nursing home admissions, and emergency department (ED) visits. We used fixed effects logistic regression models on unmatched and coarsened exact matched cohorts, stratified by rural/urban location.
      Results: Both urban and rural VDC recipients were significantly less likely to be admitted to VHA-paid nursing homes, compared to those receiving other VHA-paid personal care services (rural: incremental effect = -0.22, [-0.30, -0.14]; urban: incremental effect = -0.14, [-0.20, -0.07]). Rural, but not urban, VDC enrollees had significantly fewer VHA-paid acute care admissions and ED visits, relative to recipients of other VHA-paid personal care services (acute care, rural: incremental effect = -0.07, 95% CI = [-0.14, -0.01], urban: incremental effect = -0.01, [-0.06, 0.03]; ED, rural: incremental effect = -0.08, [-0.14, -0.02], urban: incremental effect = 0.01, [-0.03, 0.05]).
      Conclusions: VDC recipients had fewer incidents of potentially avoidable VHA-paid health care use, compared to similar veterans receiving other VHA-paid personal care services. These differences were more pronounced among rural VDC recipients than urban VDC recipients.
      (© 2022 The American Geriatrics Society. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)
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    • Grant Information:
      I01 HX002376 United States HX HSRD VA; IK2 HX001775 United States HX HSRD VA; IP1 HX002374 United States HX HSRD VA; SDR 16-196 United States HX HSRD VA
    • Contributed Indexing:
      Keywords: long-term care; nursing home admission; rural/urban variation; self-directed care; veteran-directed care
    • Publication Date:
      Date Created: 20220113 Date Completed: 20220517 Latest Revision: 20230505
    • Publication Date:
      20240104
    • Accession Number:
      PMC9106846
    • Accession Number:
      10.1111/jgs.17656
    • Accession Number:
      35026056