# Putting the puzzle together: Leveraging dual use to improve care for Veterans living with dementia

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2022 · —

## Abstract

Background: The number of Veterans living with dementia (VLWD) will increase by 2030 to
nearly 340,000; these VLWD and their caregivers often have complex psychosocial and health
needs. Coordinating this care is complicated by the fact that most VLWD are Medicare-eligible
and therefore use care both through the VA and Medicare. Unfortunately, dual use is often
associated with duplication of services and potentially inappropriate care. In light of these
complexities, VHA Directive 1140.12 from October 2019 mandated that VA facilities establish a
Dementia System of Care to provide person-centered services for these VLWD. Because the
design of dementia care services is left to individual VA facilities, national variation affords a
unique opportunity to learn from particularly successful facilities.
Significance: The proposed study will provide important new knowledge to advance the
HSR&D priorities of long-term care/aging, access to care, and primary care practice. This
knowledge will be achieved by linking patient-level VA data, Medicare claims, and the GECDAC
Residential History File, enacting the VA Office of Research and Development’s Research
Priority of putting VA data to work for Veterans.
Innovation and Impact: This will be the first: (1) comprehensive analysis of non-VA care used
by VLWD, including both Medicare- and VA-reimbursed community care; (2) analysis of dual
use at the VA facility level, which is critical data for operational purposes; and (3) analysis of
dementia care since the VHA Dementia System of Care directive. Finally, we will include the
voice of VLWD and caregivers in both facility interviews and as Stakeholder Panel members.
Specific Aims: (1) Characterize the associations of dual use and continuity of care with the
Veteran-centered outcome of home time and how home time varies across VA facilities. (2)
Assess facility-level strategies that promote home time and the acceptability of these strategies
to Veterans and caregivers. (3) Develop a toolkit of dementia care strategies that facilities can
use to enhance VLWD care delivery.
Methodology: In this explanatory sequential mixed methods study, we will first identify
community-dwelling VLWD and link their VA data and Medicare claims with the GECDAC
Residential History File. Then, we will examine the association of dual use of outpatient and
prescription medications with home time, and whether this is moderated by continuity of care.
We will collapse these findings to examine dual use, continuity of care, and home time at the
facility level. With input from a Stakeholder & Expert Panel, we will identify four high- and four
low-performing VA facilities and conduct semi-structured interviews focused on local dementia
care strategies with VA providers, VLWD-caregiver dyads, and a non-VA community care
coordinator (n=9 interviews per facility). Finally, we will integrate our Aims 1 and 2 findings and,
with Stakeholder & Expert Panel input, develop a dementia care toolkit consis...

## Key facts

- **NIH application ID:** 10414417
- **Project number:** 1I01HX003424-01A1
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Sarah Krein
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-04-01 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10414417

## Citation

> US National Institutes of Health, RePORTER application 10414417, Putting the puzzle together: Leveraging dual use to improve care for Veterans living with dementia (1I01HX003424-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10414417. Licensed CC0.

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