Recognizing the Needs of High-Need High-Risk Veterans

Abstract

Introduction: Understanding the needs of higher-risk older adult patients can support the delivery of high quality and patientcentered healthcare. We sought to characterize the physical, functional, social and psychological needs of High-Need High-Risk (HNHR) Veterans. We hypothesized that the concept of frailty could be useful in identifying the highest-risk HNHR patients and characterizing their needs. Methods: We conducted a cross-sectional study of Veterans in the Miami Veterans Affairs Healthcare System who were identified as High-Need High-Risk by the Department of Veterans Affairs (VA) using data analytic techniques. We analyzed data of 634 Veterans who completed questionnaires by mail, telephone or in person. We assessed the Veterans' frailty status and needs in the physical, functional, psychological and social domains. Beyond descriptive statistics, we used Chi-square (χ 2 ) test, one-way ANOVA and Kruskal-Wallis to analyze whether there were differences in Veterans' needs in relation to frailty status. Results: The HNHR Veterans who participated in the questionnaire had complex needs that spanned the physical, functional, psychological, and social domains. We observed a potential mismatch between functional needs and social support; over two-thirds of respondents endorsed having dependence in at least one ADL but only about a third of respondents reported having a caregiver. Patients with frailty had higher levels of functional dependence and were more likely than the other HNHR respondents to report recent falls, recent hospitalizations, depression, and transportation issues. Conclusion: High-Need High-Risk Veterans have complex needs related to the physical, functional, psychological and social domains. Within the HNHR population, HNHR Veterans with frailty appear to have particularly high levels of risk and multidomain needs. Increased attention to identifying members of these groups and aligning them with biopsychosocial interventions that are targeted to their specific needs may support development of appropriate strategies and care-models to support HNHR Veterans.

Measuring the unmet needs of American military Veterans and their caregivers: Survey protocol of the HERO CARE survey

“…We modified the Veteran survey from a questionnaire we previously developed and fielded to over 1,300 high‐heed, high‐risk Veterans (Text S3). 32,33 …”

“…We modified the Veteran survey from a questionnaire we previously developed and fielded to over 1,300 highheed, high-risk Veterans (Text S3). 32,33 Both surveys started with an environmental scan of relevant instruments, other large surveys, and VA programs and metrics. The environmental scan included a systematic literature review, employing guidance from an experienced University of Miami librarian to develop a search algorithm, identify key domains and potential factors for unmet needs among older adults, and validated instruments used in prior studies.…”

Understanding care coordination for Veterans with complex care needs: protocol of a multiple-methods study to build evidence for an effectiveness and implementation study

“…Although evidence to date is inconsistent regarding the design and effectiveness of tools to assess care coordination needs ( 10 – 12 ), care coordination appears to be most successful for patients with conditions that increase their risk for hospitalization, mortality and higher costs ( 3 , 9 , 13 , 14 ). Such high-risk, high need populations are not limited to those with a specific set of comorbidities and may include people with health-related social needs ( 15 , 16 ). Care coordination for people with complex care needs is multidimensional and spans a continuum of care ( 17 – 19 ).…”

Peer-to–Patient-Aligned Care Team (Peer-to-PACT; P2P), a Peer-Led Home Visit Intervention Program for Targeting and Improving Long-term Care Services and Support for Veterans With High Needs and High Risk: Protocol for a Mixed Methods Feasibility Study

“…The VA Geriatric and Extended Care (GEC) office recommends that veterans with HNHR be enrolled in long-term services and supports programs, including home-and community-based services, for best outcomes. Veterans with HNHR have complex needs that include not only physical but also mental, functional, and social needs, specifically frailty, social isolation, mobility challenges, and self-care deficits [4][5][6][7][8].…”