Community Nursing Home Program Oversight: Can the VA Meet Increased Demand for Community-Based Care?

Autor:	Levy C; Rocky Mountain Regional Veterans Affairs Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado.; University of Colorado School of Medicine, Aurora., Magid KH; Rocky Mountain Regional Veterans Affairs Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado., Corneau E; Providence Veterans Affairs Medical Center, Rhode Island., Cornell PY; Providence Veterans Affairs Medical Center, Rhode Island.; Brown University School of Public Health, Providence, Rhode Island., Haverhals L; Rocky Mountain Regional Veterans Affairs Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado.; University of Colorado School of Medicine, Aurora.
Jazyk:	angličtina
Zdroj:	Federal practitioner : for the health care professionals of the VA, DoD, and PHS [Fed Pract] 2023 Oct; Vol. 40 (10), pp. 338-343. Date of Electronic Publication: 2023 Oct 15.
DOI:	10.12788/fp.0421
Abstrakt:	Background: The US Department of Veterans Affairs (VA) Community Nursing Home (CNH) program provides in-person oversight monitoring the quality of care of veterans in VA-contracted community-based skilled nursing homes. The number of veterans receiving CNH care is projected to increase by 80% by 2037. Methods: Retrospective observational data describing the distance between contracted facilities and VA medical centers (VAMCs) were linked to Centers for Medicare and Medicaid monthly Nursing Home Compare and Brown University Long Term Care: Facts on Care in the US data. Qualitative interviews with CNH-based staff and VA-based CNH program oversight team members were conducted using a semistructured interview guide. Quantitative and qualitative data were analyzed independently and integrated during the interpretation of results. Results: The number of CNHs per VAMC ranged from 1 to 68 (mean, 18). One in 4 CNHs were > 70 miles from the associated VAMC; among CNHs with 2 to 5 veterans, 44% were located > 50 miles away. Four qualitative themes emerged regarding VA CNH oversight: (1) benefits of VA CNH team engagement/ visits, including quality assurance and care coordination; (2) burden of VA CNH oversight due to geographic dispersion with too few or too many veterans at each to achieve efficiency; (3) oversight burdens and limited staffing restricted ability to add CNHs; and (4) remote access and interoperability of electronic health records and balancing the number of CNH veterans with staffing could facilitate successful oversight. Conclusions: The success of the CNH program will depend on the exchange of information and matching available resources to veterans' needs. At a time when strategies to ease the burden on NHs and VA CNH coordinators are needed, the VA needs to improve to properly scale the program. Competing Interests: Author disclosures The authors have no conflict of interest to report. This work was supported by the United States Department of Veterans Affairs, Veterans Health Administration, Office of Health Services Research and Development, (IIR #17-231). (Copyright © 2023 Frontline Medical Communications Inc., Parsippany, NJ, USA.)
Databáze:	MEDLINE
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