VA home-based primary care interdisciplinary team structure varies with Veterans' needs, aligns with PACE regulation

Area of Science:

• Gerontology
• Health Services Research
• Veterans Health Administration

Background:

• Interdisciplinary team (IDT) care is crucial for frail elders in home-based primary care (HBPC).
• Traditional full IDT models are resource-intensive.
• The Program of All-inclusive Care for the Elderly (PACE) regulation allows flexible team structures (Core+).

Purpose of the Study:

• To evaluate if Department of Veterans Affairs (VA) HBPC programs have adopted flexible IDT structures.
• To determine if these structures align with Veteran needs, similar to PACE.
• To assess the association between team patterns and patient characteristics.

Main Methods:

• Cross-sectional analysis of 139 VA HBPC programs and 55,173 Veterans in fiscal year 2018.
• Classified patient frailty using VA HNHR v2 and medical complexity using the JEN frailty index (JFI).
• Grouped patient visits into interdisciplinary team types: Full IDT, Core+, and Home Health+ (HHA+).

Main Results:

• 54% of Veterans received Core+ care, 21% received Full IDT care, and 16% received HHA+ care.
• Team type significantly associated with medical complexity (p < 0.0001).
• High-risk Veterans were more likely to receive Full IDT care, while low-risk Veterans received HHA+ care.

Conclusions:

• VA HBPC demonstrates a strong association between team patterns and patient frailty.
• Care is tailored to match Veteran needs, indicating adoption of flexible IDT approaches.
• This suggests efficient resource allocation in HBPC based on patient complexity.