Defining successful program configurations in VA home-based primary care: a study protocol to identify key...

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.