Expanding Access to Comprehensive Geriatrics Care Via Telehealth

Not Applicable

Terminated

Brief Summary: The overall objective of the TeleGRACE project is to improve the care and outcomes of older Veterans with a recent inpatient stay by expanding access to the evidence-based GRACE program, by evaluating a telehealth implementation.

Detailed Description: The TeleGRACE evaluation will focus on three primary aims and a secondary aim:

Primary Aim 1: To examine the effectiveness of the TeleGRACE program, the investigators designed a randomized controlled implementation trial (RCT) powered for the primary outcome of 90-day all-cause mortality. The investigators will also examine its effectiveness for the secondary outcomes including 90-day readmissions, 1-year ED utilization (VA and non-VA), 1-year all-cause readmissions, 1-year mortality, as well as patient, caregiver, and staff satisfaction. The investigators hypothesize that patients who receive TeleGRACE will have lower 90-day mortality than patients in usual care.

Primary Aim 2: to examine the implementation of the TeleGRACE program. The implementation strategy is reflecting \& evaluating. Implementation outcomes are based on the REAIM framework and include reach, efficacy (Aim 1), and implementation (total number of Veterans served, fidelity).

Primary Aim 3: to conduct a business-case analysis (BCA). The business case analysis will calculate the net financial savings or loss for TeleGRACE as the difference in the overall intervention costs and savings due to downstream benefits for patients receiving TeleGRACE versus usual care controls.

Recruitment & Eligibility

Inclusion Criteria

Veterans discharged from the Indianapolis VA medical center (VAMC) for an medical/surgical diagnosis (excludes substance use disorder-related admissions; excludes planned admissions) within the prior week
Age 70 years
Not enrolled in home-based primary care (HBPC)
Not enrolled in hospice
Not in dialysis
Primary care visit within VA in the prior 2 years
Not residing in nursing home, skilled nursing facility, or CLC.
Living >20 miles but <60 miles from the Indianapolis VAMC facility
CAN score 95th percentile for mortality or missing CAN score
Discharged from the hospital alive

Exclusion Criteria

Patients who have been randomized to the control arm after their index hospitalization who become readmitted to the hospital may not be re-randomized.
By definition, GRACE patients are not eligible for TeleGRACE due to the drive distance >20 miles from the Indianapolis VAMC
Enrolled in home-based primary care (HBPC)
Enrolled in hospice
Dialysis (hemodialysis or peritoneal dialysis)
Residing in nursing home, skilled nursing facility, or CLC.
Living <20 miles or 60 miles from the Indianapolis VAMC facility

Arm && Interventions

Group	Intervention	Description
TeleGRACE	TeleGRACE	Patients receive a virtual home visit and care from the GRACE team

Primary Outcome Measures

Name	Time	Method
90-day All-cause Mortality	90-days from discharge from the index hospitalization	The primary outcome is 90-day all-cause mortality measured from the date of discharge from the index hospitalization.

Secondary Outcome Measures