{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T23:03:26Z","timestamp":1791673406612,"version":"4.3.4"},"reference-count":49,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T00:00:00Z","timestamp":1695945600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Veterans Affairs (VA) home\u2010based primary care (HBPC) provides comprehensive longitudinal care to patients with complex, chronic disabling disease. While enrollment is associated with lower hospitalization rates and costs, detailed trajectories have not been well described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a longitudinal descriptive study of patients newly enrolled in VA HBPC in fiscal year (FY) 2015. We extracted demographics, comorbidities, functional status, and social supports from VA and Medicare data and examined patterns of care and clinical outcomes, including hospital, nursing home (NH), hospice use and mortality from FY2015\u20132017. We present results using descriptive statistics, alluvial plots, and heat maps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 10,571 HBPC enrollees in FY2015; mean age was 77.7. HBPC patients commonly had chronic medical conditions with high self\u2010management burden (e.g., diabetes 48.2%) and disabling conditions such as dementia (39.3%). Over half had \u22652 deficits in activities of daily living, 46% had caregivers with functional limitations or no caregiver, and 25% resided in a socially deprived area. Patients experienced variable care trajectories. Mean time enrolled in HBPC was 331\u2009days, 8.3% of patients were discharged after 3\u2009months, and 22.8% stayed enrolled for over 2\u2009years. Institutional health care use declined in the 6\u2009months after initial enrollment: (e.g., hospital: 41%\u201325%, NH: 34%\u201311%). At 2\u2009years, 36% of patients had died; among decedents, 58% received hospice and 72% died in a non\u2010institutional setting. In the last 180\u2009days of life, 84% of time was spent at home, and once enrolled in hospice, 97% of time was spent outside of institutional care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HBPC patients experience highly variable care trajectories but on average have reductions in acute care use and spend a majority of time in non\u2010institutional settings. These data allow for a nuanced understanding of HBPC, providing a platform for monitoring, evaluating, and improving program function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.18607","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T07:00:33Z","timestamp":1695970833000},"page":"80-90","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Trajectories of care and outcomes of Veterans receiving home\u2010based primary care"],"prefix":"10.1111","volume":"72","author":[{"given":"Samuel T.","family":"Edwards","sequence":"first","affiliation":[{"name":"Section of General Internal Medicine VA Portland Health Care System  Portland Oregon USA"},{"name":"Division of General Internal Medicine and Geriatrics Oregon Health and Science University  Portland Oregon USA"},{"name":"Center to Improve Veteran Involvement in Care VA Portland Health Care System  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"O'Neill","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care VA Portland Health Care System  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meike","family":"Niederhausen","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care VA Portland Health Care System  Portland Oregon USA"},{"name":"Oregon Health and Science University \u2013 Portland State University School of Public Health Oregon Health and Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apoorva","family":"Salvi","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care VA Portland Health Care System  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery","family":"Laliberte","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care VA Portland Health Care System  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somnath","family":"Saha","sequence":"additional","affiliation":[{"name":"Section of General Internal Medicine VA Portland Health Care System  Portland Oregon USA"},{"name":"Center to Improve Veteran Involvement in Care VA Portland Health Care System  Portland Oregon USA"},{"name":"Division of General Internal Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise M.","family":"Hynes","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care VA Portland Health Care System  Portland Oregon USA"},{"name":"Health Management and Policy Program, School of Public Health and Nutrition, College of Health Oregon State University  Corvallis Oregon USA"},{"name":"School of Nursing Oregon Health and Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Pizer","sequence":"additional","affiliation":[{"name":"Health Law, Policy, and Management Boston University School of Public Health  Boston Massachusetts USA"},{"name":"Partnered Evidence\u2010Based Policy Resource Center Department of Veterans Affairs  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Kinosian","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Geriatrics and Extended Care Data Analysis Center Cpl Michael J Crescenz VA Medical Center  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,29]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"U.S. Department of Veterans Affairs. VHA Dir 1411.Home\u2010based primary care special population patient aligned care team program. 2017."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-020-06356-2"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14517"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16171"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gny174"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621424.2022.2056106"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18153"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2023.03.016"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14176"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12974"},{"key":"e_1_2_11_12_1","volume-title":"Home\u2010Based Primary Care Interventions","author":"Totten AM","year":"2016"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17365"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17999"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17426"},{"key":"e_1_2_11_16_1","unstructured":"Centers for Medicare and Medicaid Services.Independence at Home demonstration year 1 practice results. 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