Utilization and Cost Effects of the VHA Caring for Older Adults and Caregivers at Home (COACH) Program.
Wei SongOrna IntratorJack TwerskyJudith DavagninoBruce KinosianDarryl WielandPublished in: Medical care research and review : MCRR (2020)
Since 2010, the Veterans Health Administration has initiated a home-based Caring for Older Adults and Caregivers at Home (COACH) program to provide clinical support to dementia patients and family caregivers. But its impact on health care utilization and costs is unknown. We compared 354 COACH care recipients with a propensity score weighted comparison group of 9,857 community-dwelling Veterans during fiscal years 2010-2015. In 1-year follow-up, COACH program was associated with a lower rate of long-term nursing home placement (average treatment effect on the treated [ATT] -3%; p = .01). The program increased utilization of emergency services (ATT 6%; p = .01), hospitals (ATT 10%; p < .001), and personal care services (ATT 31%; p < .001). Health care costs were also significantly increased. Improved access to services may have enabled COACH Veterans to stay at home longer. As one of Veterans Health Administration's top priorities to expand caregiver assistance programs, COACH seems to be a promising model for a nationwide implementation.
Keyphrases
- healthcare
- quality improvement
- public health
- palliative care
- community dwelling
- physical activity
- newly diagnosed
- end stage renal disease
- health information
- primary care
- chronic kidney disease
- ejection fraction
- emergency department
- mild cognitive impairment
- computed tomography
- patient reported outcomes
- prognostic factors
- cross sectional
- pain management
- risk assessment
- social media
- patient reported