Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT04795791 |
| Other study ID # |
SDR 16-194 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
April 27, 2017 |
| Est. completion date |
March 31, 2020 |
Study information
| Verified date |
March 2021 |
| Source |
Providence VA Medical Center |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial 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.
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 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 and has partnered with the Program Evidenced-based Policy Resource Center
(PEPReC) for a randomized, stepped-wedge dissemination and an evaluation of utilization
outcomes. 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,
interviews will be conducted with Veterans to capture 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, the 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 project 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.
