Evaluation of veteran-directed home and community based services on older veterans’ health care use and costs

Evaluation of Veteran-Directed Home and Community Based Services on older veterans’ health care use and costs: a stepped wedge cluster randomized trial

Status

Active, not recruiting

Phases

Unknown

Study type

Observational

Source

ISRCTN

Registry ID

ISRCTN12228144

Enrollment

1800

Registered

2017-03-21

Start date

2017-03-22

Completion date

Unknown

Last updated

2022-09-05

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Functional (needs assistance with 3 or more Activities of Daily Living) and/or cognitive limitations that place individuals at risk of nursing home placement Mental and Behavioural Disorders Functional (needs assistance with 3 or more Activities of Daily Living) and/or cognitive limitations that place individuals at risk of nursing home placement

Interventions

The VD-HCBS program is a participant-directed program that enables veterans with functional or cognitive limitations to purchase care services in their homes. The goal of this program is to reduce the

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: VAMC inclusion criteria (cluster level): Site does not yet have an operational VD-HCBS program VHA enrollee criteria (individual level)*: 1. Aged 75 and older 2. Jen Frailty Index (VA-data only) of 6 or higher 3. Had at least one inpatient or outpatient visit in the VHA system in the past year” *Exact enrollee criteria will differ by site, as sites are allowed flexibility in choosing who to refer to the program

Exclusion criteria

Exclusion criteria: VAMC criteria (cluster level) 1. Site has nearly completed readiness review and is unable to delay enrollment 2. Facility leadership not interested in implementing VD-HCBS program VHA enrollee criteria (individual level) There are no exclusion criteria for individual enrollment in VHA.

Design outcomes

Primary

Measure	Time frame
1. Any hospitalization is measured using administrative data collected by the VA Corporate Data Warehouse at 60-day increments for six months 2. Any emergency department visit is measured using administration data collected by the VA Corporate Data Warehouse at 60-day increments for six months 3. Nursing home admissions (VA community living center and contracted nursing homes) is measured using administrative data collected by the VA Corporate Data Warehouse at 60-day increments for six months 4. Total health care costs (VA, Medicare, Medicaid) are assessed using administration data collected by VA Corporate Data Warehouse data, Medicare data, and Medicaid data at 60-day increments for six months	—

Measure

Time frame

1. Any hospitalization is measured using administrative data collected by the VA Corporate Data Warehouse at 60-day increments for six months 2. Any emergency department visit is measured using administration data collected by the VA Corporate Data Warehouse at 60-day increments for six months 3. Nursing home admissions (VA community living center and contracted nursing homes) is measured using administrative data collected by the VA Corporate Data Warehouse at 60-day increments for six months 4. Total health care costs (VA, Medicare, Medicaid) are assessed using administration data collected by VA Corporate Data Warehouse data, Medicare data, and Medicaid data at 60-day increments for six months

—

Secondary

Measure	Time frame
1. Frequency of hospitalisation is measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day increments for six months 2. Incidence and frequency of ambulatory care sensitive hospitalization is measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day incrementsfor six months 3. Costs attributed to HCBS measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day increments for six months 4. Costs attributed to nursing home stays are measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day increments for six months 5. Costs attributed to outpatient care are measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day increments for six months 6. Days at home (days not in an acute care setting or long-term care facility) are measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day increments for six months	—

Measure

Time frame

1. Frequency of hospitalisation is measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day increments for six months 2. Incidence and frequency of ambulatory care sensitive hospitalization is measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day incrementsfor six months 3. Costs attributed to HCBS measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day increments for six months 4. Costs attributed to nursing home stays are measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day increments for six months 5. Costs attributed to outpatient care are measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day increments for six months 6. Days at home (days not in an acute care setting or long-term care facility) are measured using administrative data collected by the VA, Medicare, and/or Medicaid at 60-day increments for six months

—

Countries

United States of America

Outcome results

None listed

Source: ISRCTN (via WHO ICTRP) · Data processed: Feb 4, 2026