背景:退伍军人指导护理(VDC)计划通过提供资金雇用退伍军人选择的护理人员来帮助有长期机构护理风险的退伍军人留在家中。VDC是通过退伍军人事务部(VA)医疗中心(VAMC)与第三方老龄化和残疾网络机构提供商之间的合作伙伴关系运营的。
目标:我们的目标是确定促进者,障碍,1个地区的7个VAMC的VDC实施和调整:退伍军人综合服务网络(VISN)8,覆盖佛罗里达州,南乔治亚,波多黎各,美属维尔京群岛。我们还试图了解领导和利益相关者对VDC计划的影响和实施,并确定VISN8的VDC计划所服务的退伍军人,并描述他们基于家庭和社区的服务使用。最后,我们希望将VISN8中VDC计划所服务的退伍军人与整个VA中VDC计划所服务的退伍军人进行比较。此信息旨在用于确定策略并提出建议,以指导VISN8中的VDC计划扩展。
方法:混合方法研究设计包括电子交付调查,半结构化面试,和行政数据。它由实施研究综合框架(CFIR2.0版)指导。参与者包括VAMC的工作人员以及VISN8的老龄化和残疾网络机构的合作伙伴,这些VAMC和VISN8的领导,参加VDC的退伍军人,和拒绝VDC登记的退伍军人及其照顾者。我们采访了选定的VAMC社会工作现场负责人,老年医学和扩展护理,和照顾者支持计划。每位受访者将被要求完成一份包括其个人特征信息的面试前调查,VDC计划的经验,以及根据CFIR(2.0版)框架对程序方面的看法。参与者将完成半结构化面试,涵盖与受访者和主持人相关的结构,障碍,以及现场VDC实施中的调整。
结果:我们将计算描述性统计数据,包括均值,SDs,以及调查答复的百分比。主持人,障碍,登记的患者数量,人员配置也将被介绍。访谈将使用由CFIR域和构造指导的快速定性技术进行分析。将对VISN8的结果进行整理,以确定VDC扩展的策略。我们将使用管理数据来描述VISN8中计划所服务的退伍军人。
结论:VA优先考虑在全国范围内推广VDC,这项研究将为这些扩展工作提供信息。这项研究的结果将提供有关员工经验的信息,领导力,退伍军人,和VDC计划中的护理人员,并确定计划促进者和障碍。这些结果可用于改善计划交付,促进VISN8内的增长,并随着VDC计划的扩展在全国其他站点建立新计划。
■DERR1-10.2196/57341。
BACKGROUND: The Veteran-Directed Care (VDC) program serves to assist veterans at risk of long-term institutional care to remain at home by providing funding to hire veteran-selected caregivers. VDC is operated through partnerships between Department of Veterans Affairs (VA) Medical Centers (VAMCs) and third-party Aging and Disability Network Agency providers.
OBJECTIVE: We aim to identify facilitators, barriers, and adaptations in VDC implementation across 7 VAMCs in 1 region: Veterans Integrated Service Network (VISN) 8, which covers Florida, South Georgia, Puerto Rico, and the US Virgin Islands. We also attempted to understand leadership and stakeholder perspectives on VDC programs\' reach and implementation and identify veterans served by VISN 8\'s VDC programs and describe their home- and community-based service use. Finally, we want to compare veterans served by VDC programs in VISN 8 to the veterans served in VDC programs across the VA. This information is intended to be used to identify strategies and propose recommendations to guide VDC program expansion in VISN 8.
METHODS: The mixed methods study design encompasses electronically delivered surveys, semistructured interviews, and administrative data. It is guided by the Consolidated Framework for Implementation Research (CFIR version 2.0). Participants included the staff of VAMCs and partnering aging and disability network agencies across VISN 8, leadership at these VAMCs and VISN 8, veterans enrolled in VDC, and veterans who declined VDC enrollment and their caregivers. We interviewed selected VAMC site leaders in social work, Geriatrics and Extended Care, and the Caregiver Support Program. Each interviewee will be asked to complete a preinterview survey that includes information about their personal characteristics, experiences with the VDC program, and perceptions of program aspects according to the CFIR (version 2.0) framework. Participants will complete a semistructured interview that covers constructs relevant to the respondent and facilitators, barriers, and adaptations in VDC implementation at their site.
RESULTS: We will calculate descriptive statistics including means, SDs, and percentages for survey responses. Facilitators, barriers, number of patients enrolled, and staffing will also be presented. Interviews will be analyzed using rapid qualitative techniques guided by CFIR domains and constructs. Findings from VISN 8 will be collated to identify strategies for VDC expansion. We will use administrative data to describe veterans served by the programs in VISN 8.
CONCLUSIONS: The VA has prioritized VDC rollout nationwide and this study will inform these expansion efforts. The findings from this study will provide information about the experiences of the staff, leadership, veterans, and caregivers in the VDC program and identify program facilitators and barriers. These results may be used to improve program delivery, facilitate growth within VISN 8, and inform new program establishment at other sites nationwide as the VDC program expands.
UNASSIGNED: DERR1-10.2196/57341.