# Aligning Post-Acute Care with Veterans Values and Priorities

> **NIH VA IK2** · PHILADELPHIA VA MEDICAL CENTER · 2024 · —

## Abstract

Background
Every day, more than 600 hospitalized Veterans face a time-pressured, complex, high-stakes choice regarding
post-acute care (PAC) supports following hospitalization. While nearly all efforts to improve PAC choice have
focused on which provider to use, the type of PAC services selected can have life-altering implications in terms
of patient outcomes, finances, and caregiver burden. For the majority of older Veterans, the main choices are
to go to a skilled nursing facility (SNF) or go home, with or without home health care (HH). In preliminary work,
we found that Veterans are infrequently included in post-acute care decision-making and are not informed
about tradeoffs between PAC settings.
Significance/Impact
This research program will provide critical knowledge to Veterans, clinicians, and policy makers about
Veterans' outcomes across PAC settings, while also piloting a tool to support high-quality decision-making by
better aligning Veterans priorities with services.
Innovation
This theoretically driven mixed methods approach will draw from decision science, use large datasets, and
incorporate user-centered design to reveal new insights into what matters most to Veterans discharged to
PAC, and how best to align care with their values and goals. Veterans' priorities and goals for PAC are
unknown, and our approach will establish important patient-centered outcomes for the VA to consider in
achieving patient-centered PAC. I will use these findings to develop a new PAC decision support tool that is
feasible and acceptable to patients, caregivers, and clinicians.
Specific Aims
My specific aims include: 1) Identify attributes of PAC that matter most to a diverse sample of older Veterans
and caregivers when making decisions about post-discharge supports. 2) Determine differences in 100-day
outcomes for older hospitalized Veterans who receive PAC via SNF vs. HH. 3) Develop and pilot a decision
tool to elicit hospitalized Veterans' priorities for PAC, so they may be shared with the healthcare team.
Methodology
To better inform PAC decisions and evidence-based practice, in Aim 1 I will first use a mixed-methods
approach informed by decision-science to identify what matters most to Veterans and caregivers when
deciding between care types. In Aim 2, I will compare patient-centered outcomes between PAC settings to
identify important trade-offs in SNF vs. HH. I will use advanced statistical techniques and a unique dataset (the
2012-16 Residential History File) to accomplish this aim. Last, in Aim 3 with methods from user centered
design, I will rigorously identify what matters most to Veterans when making PAC decisions and pilot a
decision tool.
Next Steps/Implementation
This research program will help better out understand the tradeoffs in outcomes between post-acute care
services, while piloting a tool to support decision-making.

## Key facts

- **NIH application ID:** 10606531
- **Project number:** 5IK2HX003470-02
- **Recipient organization:** PHILADELPHIA VA MEDICAL CENTER
- **Principal Investigator:** Kirstin Manges Piazza
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-04-01 → 2027-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10606531

## Citation

> US National Institutes of Health, RePORTER application 10606531, Aligning Post-Acute Care with Veterans Values and Priorities (5IK2HX003470-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10606531. Licensed CC0.

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