# Defining Successful Program Configurations in Home-Based Primary Care

> **NIH VA I01** · PORTLAND VA MEDICAL CENTER · 2024 · —

## Abstract

Background: Home-Based Primary Care (HBPC) is a unique home care program that provides
comprehensive, longitudinal primary care to Veterans with complex chronic disease with an interdisciplinary
team of VA staff. HBPC enrollment is associated with reduced hospitalizations, reduced health care costs, and
high patient satisfaction, and is a critical component of the Office of Geriatrics and Extended Care’s (GEC’s)
strategy to shift long term services and supports into home and community-based services.
Significance: GEC plans to expand HBPC by 75 sites by 2026, but there is substantial variation in individual
HBPC site structures, populations served, care delivery patterns, and clinical outcomes. It is unknown whether
this variation represents variable fidelity to the HBPC clinical model and an opportunity to improve efficiency
vs. appropriate flexibility and adaptation to varying patient needs and local contexts. Given planned expansion,
a detailed understanding of program variation is needed to understand which configurations of program
features are successful in what contexts and why.
Innovation & Impact: This proposal uses configurational analysis, an emerging mixed-methods approach, to
identify configurations of HBPC program and contextual characteristics associated with longer patient home
time, a novel patient-centered outcome measure. Patient home time is a novel measure that captures a
universal goal in HBPC, the time a Veteran can live independently at home. Results of this study will inform
HBPC expansion and will help existing engage in context-tailored quality improvement efforts.
Specific Aims: Aim 1: Assess variation among HBPC sites in contextual and modifiable factors, patient
characteristics, and care delivery patterns, and identify site and patient level correlates of clinical outcomes.
Aim 2: Assess HBPC team member and Veteran perspectives on potential mechanisms of success in sites
that are high and low performing in patient home time. Aim 3: Identify factors that distinguish HBPC sites with
higher versus lower performance in patient home time.
Methodology: Aim 1 is a quantitative study in which we will build descriptive profiles of all 440 HBPC sites
using VA and Medicare data and perform regression analysis and cluster analyses to examine site and patient
level correlates of clinical outcomes. In Aim 2 we will perform qualitative interviews of HBPC clinicians, staff,
and Veterans, and observation of work practices in 10 HBPC sites with high performance and 10 with low
performance in patient home time. Aim 3 will use configurational analysis, a cross case analysis method rooted
in mathematical set theory, to identify features identified in Aims 1 and 2 that are necessary and/or sufficient
for longer patient home time.
Next Steps/Implementation: We will work with partners in GEC to use identified configurations of HBPC site
features to inform HBPC expansion, and to facilitate the development of a complexity informed, adaptive
...

## Key facts

- **NIH application ID:** 10929967
- **Project number:** 5I01HX003650-02
- **Recipient organization:** PORTLAND VA MEDICAL CENTER
- **Principal Investigator:** Samuel T Edwards
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-09-01 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10929967

## Citation

> US National Institutes of Health, RePORTER application 10929967, Defining Successful Program Configurations in Home-Based Primary Care (5I01HX003650-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10929967. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*