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Area of Science:

  • Geriatric Medicine
  • Health Services Research
  • Healthcare Management

Background:

  • The Department of Veterans Affairs (VA) serves an aging population.
  • The VA's Home-Based Primary Care (HBPC) program offers longitudinal primary care to high-risk Veterans.
  • HBPC implementation varies across sites, presenting an opportunity to study heterogeneity.

Purpose of the Study:

  • To investigate real-world heterogeneity in HBPC program implementation.
  • To identify factors influencing patient outcomes, particularly home time.
  • To inform future expansion of the HBPC program.

Main Methods:

  • Exploratory sequential mixed methods design.
  • Primary outcome: Patient home time in the last 180 days of life.
  • Secondary outcomes: Patient satisfaction, utilization (ED visits, hospitalizations, long-term care days), care transitions, hospice use, site of death.

Main Results:

  • Analysis of contextual, operational, cultural, and care delivery factors.
  • Identification of configurations distinguishing high- versus low-home time sites.
  • Qualitative case studies at 10 high and 10 low home time sites.

Conclusions:

  • Real-world heterogeneity in program implementation can be leveraged to identify key success factors.
  • Understanding site-specific HBPC features can guide program expansion and improvement.
  • Distinguishing adaptive variation from inefficiency is crucial for optimizing care for older adults.