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Harnessing Data to Improve Care for Veterans Residing in Community Nursing Homes

At age 77, John, a Veteran with service-related injuries is cared for in his home by his wife with support from VA Home and Community Based Services, which help chronically ill or disabled Veterans - of any age - remain in their homes. But when John's wife suddenly died, he could no longer live independently and his family made the difficult decision to place him in a community nursing home (CNH).

Veterans, like John, with a service connection of >70% are entitled to VA-paid CNH care. As a result, VA paid nearly $800 million for CNH care in FY15. Importantly, the number of Veterans eligible for CNH care will double in the next decade. To address the need for data on the quality of CNH care, VA's Office of Geriatrics and Extended Care (GEC) Data and Analyses Center developed a CNH Dashboard that utilizes quality data from the Centers for Medicare and Medicaid Services (CMS) for reporting on nursing home care. The CNH Dashboard compares the quality of the VA-paid CNH facilities to other VA facilities in the area.

One of QUERI's Partnered Evaluation Initiatives - Disseminating a Dashboard for VA Purchased Community Nursing Homes - is conducting a stepped-wedge roll out of the CNH Dashboard across the VA healthcare system to compare and improve the quality of CNH facilities . The partner for this project is VA's Office of Geriatrics and Extended Care. In addition to dissemination, the CNH Dashboard QUERI initiative has developed a more thorough understanding of CNH policy and facility selection at the VAMC level and will develop Veteran-specific measures for measuring CNH quality.

One unintended benefit of the CNH Dashboard QUERI has been the opportunity to bring together a network of VA Professionals dedicated to improving the quality of care for Veterans living in community nursing homes. Dr. James Rudolph, who leads this QUERI initiative, and directs the Center of Innovation in Long-Term Services and Supports at the Providence VAMC, states, "The CNH program exists at every VAMC , and there is a group of dedicated GEC professionals who want to help Veterans and their families make this difficult transition. I have developed a profound respect for the GEC professionals engaged in the CNH selection process. Their Veteran-centric attitude and dedication to smoothing this transition to high-quality CNH facilities is impressive."

After discussing the options with the local VAMC GEC Community Nursing Home Coordinator, John and his family visited local CNH facilities with VA contracts, before they selected one nearer to his family that provided good quality care.

The GEC-partnered CNH Dashboard QUERI was funded in 2015 and the stepped-wedge dissemination will conclude in 2017, with final analyses of the impact of the dissemination to follow.

For more information about this project, please contact James Rudolph, MD, at James.Rudolph@va.gov.