Evidence map›Paper›PMID 36054760›Full record

Observational studyJournal of the American Geriatrics Society2022

Effectiveness of the VA-Geriatric Resources for Assessment and Care of Elders (VA-GRACE) program: An observational cohort study.

Cathy C Schubert, Anthony J Perkins, Laura J Myers, Teresa M Damush, Lauren S Penney, Ying Zhang, Ashley L Schwartzkopf, Alaina K Preddie, Sam Riley, Tetla Menen and 1 more

Open access · greenAbstract readObservational Study
In one paragraph

Observational study in Journal of the American Geriatrics Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
0.8field-weighted citation impact, top 31% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 8 citations in OpenAlex.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 1 country.

Cathy C SchubertMedicine Service, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.ORCID 0000-0001-9341-1340
Anthony J PerkinsDepartment of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding expertise Through E-Health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, Indiana, USA.
Laura J MyersDepartment of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Teresa M DamushDepartment of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Lauren S PenneyDepartment of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding expertise Through E-Health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, Indiana, USA.
Ying ZhangDepartment of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding expertise Through E-Health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, Indiana, USA.
Ashley L SchwartzkopfDepartment of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding expertise Through E-Health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, Indiana, USA.
Alaina K PreddieDepartment of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding expertise Through E-Health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, Indiana, USA.
Sam RileyDepartment of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding expertise Through E-Health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, Indiana, USA.
Tetla MenenDepartment of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding expertise Through E-Health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, Indiana, USA.
Dawn M BravataMedicine Service, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.
Health Services Research & Development · USRegenstrief Institute · USRichard L. Roudebush VA Medical Center · USThe University of Texas Health Science Center at San Antonio · US

Funding

EXTEND: EXpanding expertise Through E-health Network DevelopmentI50HX003205 · VA · RLR VA MEDICAL CENTER · PI BRAVATA, DAWN MARIE, DAMUSH, TERESA M. · 2021 to 2021
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Damush HSR&D Research Career Scientist Award ApplicationIK6HX002715 · VA · RLR VA MEDICAL CENTER · PI DAMUSH, TERESA M. · 2020 to 2024
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HSRD VA IK6 HX002715
6 · The paper itself

Abstract

backgroundAs the Department of Veterans Affairs (VA) healthcare system seeks to expand access to comprehensive geriatric assessments, evidence-based models of care are needed to support community-dwelling older persons. We evaluated the VA Geriatric Resources for Assessment and Care of Elders (VA-GRACE) program's effect on mortality and readmissions, as well as patient, caregiver, and staff satisfaction.

methodsThis retrospective cohort included patients admitted to the Richard L. Roudebush VA hospital (2010-2019) who received VA-GRACE services post-discharge and usual care controls who were potentially eligible for VA-GRACE but did not receive services. The VA-GRACE program provided home-based comprehensive, multi-disciplinary geriatrics assessment, and ongoing care. Primary outcomes included 90-day and 1-year all-cause readmissions and mortality, and patient, caregiver, and staff satisfaction. We used propensity score modeling with overlapping weighting to adjust for differences in characteristics between groups.

resultsVA-GRACE patients (N = 683) were older than controls (N = 4313) (mean age 78.3 ± 8.2 standard deviation vs. 72.2 ± 6.9 years; p < 0.001) and had greater comorbidity (median Charlson Comorbidity Index 3 vs. 0; p < 0.001). VA-GRACE patients had higher 90-day readmissions (adjusted odds ratio [aOR] 1.55 [95%CI 1.01-2.38]) and higher 1-year readmissions (aOR 1.74 [95%CI 1.22-2.48]). However, VA-GRACE patients had lower 90-day mortality (aOR 0.31 [95%CI 0.11-0.92]), but no statistically significant difference in 1-year mortality was observed (aOR 0.88 [95%CI 0.55-1.41]). Patients and caregivers reported that VA-GRACE home visits reduced travel burden and the program linked Veterans and caregivers to needed resources. Primary care providers reported that the VA-GRACE team helped to reduce their workload, improved medication management for their patients, and provided a view into patients' daily living situation.

conclusionsThe VA-GRACE program provides comprehensive geriatric assessments and care to high-risk, community-dwelling older persons with high rates of satisfaction from patients, caregivers, and providers. Widespread deployment of programs like VA-GRACE will be required to support Veterans aging in place.

Indexed as

Geriatric AssessmentVeteransAftercareAgedAged, 80 and overCohort StudiesHumansIndependent LivingPatient DischargeRetrospective StudiesUnited StatesUnited States Department of Veterans Affairscare coordinationgeriatricsprogram evaluation

Identifiers

PMID36054760
PMCPMC10087268
OpenAlexW4293440033

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.