# Factors Associated with Institutional Use by Veterans in Home Based Primary Care

> **NIH VA I01** · SYRACUSE VA  MEDICAL CENTER · 2020 · —

## Abstract

VA Home Based Primary Care (HBPC) is an interdisciplinary team-based home care program that serves a
rapidly aging cohort of oldest old Veterans (85+) and younger OIF/OEF Veterans with complex chronic
disabling conditions. In 2011, approximately 15,000 Veterans were enrolled in 139 VA Medical Center HBPC
programs and an associated 101 community-based outpatient clinic locations nationwide. Although HBPC
program quality has been established along a number of institutional utilization dimensions (e.g., inpatient
days) and cost, the use of institutional care varies substantially across HBPC programs nationally. Lower
utilization of institutional care may suggest tailored approaches that optimize a veteran's care. Higher utilization
of institutional care may be an indicator of potentially inappropriate or mismanaged care that places vulnerable
HBPC Veterans at risk for complications. The proposed study seeks to identify the factors contributing to these
variations by investigating associations between HBPC organizational structures, team functioning, and eight
risk adjusted quality measures (QMs) of institutional use for hospitals, emergency departments (ED), and
nursing homes (NHs). The starting place for redesigning the health care system is to understand the
organizational structural attributes of the settings in which care occurs. To that end, a structural survey is
conducted to develop a profile of the organizational structure characteristics of HBPC programs. Structure
refers to HBPC program characteristics that affect the system's capacity to deliver primary care services to
Veterans in their home and includes HBPC program standards, team structures, and telehealth technology.
The study will then evaluate differences in HBPC interdisciplinary team functioning with regard to seven
dimensions: culture, leadership, communication, coordination, conflict management, team cohesion, and team
effectiveness through administration and analysis of the organizational assessment questionnaire (OAQ)
survey. Next, associations between HBPC organizational structures and team functioning will be analyzed to
identify organizational structures associated with more effective team functioning. Finally, the influence of
HBPC organizational structures and team functions on the quality of HBPC care will be examined with respect
to risk-adjusted QMs of institutional use: hospital and NH admissions and days, 30-day and 90-day
rehospitalizations, ED visits, and Veteran's site of death. Primary data for this proposed study will be obtained
through surveys and on-site observational visits. Secondary data will include two years of VA and CMS patient
databases (2013-2014). Findings from this study will identify organizational structures and team functions
associated with lower use of institutional care that can be integrated as best practices into policies and system
redesign initiatives to bring lower performing HBPC programs up to the level of the highest performing
progr...

## Key facts

- **NIH application ID:** 9145492
- **Project number:** 5I01HX000930-02
- **Recipient organization:** SYRACUSE VA  MEDICAL CENTER
- **Principal Investigator:** Suzanne Gillespie
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2015-07-01 → 2019-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9145492

## Citation

> US National Institutes of Health, RePORTER application 9145492, Factors Associated with Institutional Use by Veterans in Home Based Primary Care (5I01HX000930-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9145492. Licensed CC0.

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