Cari Levy, MD, PhD Denver VAMC

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Presentation transcript:

Cari Levy, MD, PhD Denver VAMC Comparative Effectiveness of the Veterans Affairs (VA) Medical Foster Home Program to Traditional VA Nursing Home Care Cari Levy, MD, PhD Denver VAMC

Dr. Levy has no financial disclosure to report.

Background: Medical Foster Home Veterans are Nursing Home (NH) eligible but prefer to receive care in a private home Rapidly expanding alternative to NH placement for Veterans 1,722 participants since inception 3 sites in 2008 “Support at Home – Where Heroes Meet Angels” Initiative 86 total sites are currently in some phase of initiating a program

Background: Medical Foster Home Veteran assumes room and board charges $1500-3000 monthly paid directly to the MFH caregiver VA provides Home Based Primary Care, oversight and MFH coordination at a cost of approximately $1500 per month

Objective Develop methodology to compare adverse outcomes in the VA Medical Foster Home (MFH) program to outcomes of Veterans who reside in a VA Community Living Center (CLC)

Methods Design: Retrospective, matched, severity-adjusted, nested case control Sample: 45 MFH, 1,051 CLC patients Location: Single VAMC from 2007-2012 Analysis: Each of 45 MFH patients matched to CLC patients on gender, age, outcomes prior to admission, observation period Outcomes: hospitalizations, incident mood/anxiety disorders, fall with injury, adverse medication events

Relative risk associated with the MFH program calculated using the odds ratio associated with adverse outcomes 95% confidence interval calculated using the natural logarithm of the odds ratio The test statistic, L, was calculated as:

Measurement of Severity

Severity Where A and B are a pair of diagnoses in . . . Severity Where A and B are a pair of diagnoses in encounter “i" of patient and the overall severity of the patient’s illness was calculated from severity of each encounter:

Accuracy of Prediction of Mortality From Severity of Illness in CLC cases C-statistic 0.78

Characteristics of Patients in MFH Cases and CLC Controls Age in years 76.77 (13.49) 72.33 (14.09) Percent male 39% 41% Severity of illness 3.29 3.15 Days from Admit to End of Period 82.04 (22.97)

Adverse Outcomes in MFH Cases and Matched CLC Controls Outcome MFH Cases MFH Outcome CLC Cases CLC OR Falls, no history 5 39 79 2.2 Falls, 1+ history 2 4 6 7 0.6 Med errors, no history 1 44 78 1.8 Med errors, 1+ history 12 Mood/anxiety, no/low history 14 8 29 15.8* Mood/anxiety, 1+ history - Hospital use, low history 48 6.1* Hospital use, high history 3 3.0 * Indicates statistical significance

Conclusions Methodology to analyze outcomes in the MFH program Compare national adverse outcomes data in MFH programs to outcomes among CLC patients

Acknowledgements Farrokh Alemi - Washington DC VAMC Bryce Sutton, Tampa VAMC Janusz Wojtusiak, Phan Giang - George Mason University Etienne Pracht, Arthur Williams - University of South Florida Allison Williams, Willy Liao, Lisa Argyros, James Blankenship - Bay Pines VAMC

Cari Levy Denver VA Medical Center Cari.levy@va.gov 303-596-2906 Contact Information Cari Levy Denver VA Medical Center Cari.levy@va.gov 303-596-2906