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Geriatrics and Extended Care


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Geriatrics and Extended Care Data and Analysis Center (GECDAC) - Measures

GECDAC develops and uses measures that summarize Veterans’ risk for particular costs of care and can help identify Veterans who require particular services. By using these measures, we can evaluate program effectiveness and cost by comparing Veterans who are at a similar risk level who do and do not receive care in the program being evaluated.

JEN Frailty Index (JFI) - The JFI creates a risk score using 13 impairment categories pulled from approximately 1800 diagnoses found to be related to the risk of long-term care admissions. GECDAC holds a license from JEN Associates to distribute JFI scores within VA for operations purposes. A validation paper of JFI is currently under review.

Independence at Home Qualification (IAH-Q) – IAH-Q was developed by the Center for Medicare and Medicaid Innovation (CMMI) for a Center for Medicare and Medicaid Services (CMS) demonstration that was based on VA’s Home Based Primary Care (HBPC) program. A person qualified for the IAH demonstration if they had two or more chronic condictions, needed assistance with two or more functional dependencies activites of daily living (ADLs), had a non-elective hospital admission within the last 12 months, and received post-acute services that generated an assessment: MDS in nursing homes OASIS in home health or IRF-PAI in inpatient rehabilitation facilities. GECDAC has modified the IAH-Q criteria for Veterans by replacing the ADL requirement with a JFI requirement. This method is still being tested.

Staffing – GECDAC compiles monthly CLC level data for nurse staffing volumes of hours per patient day for RN’s, LPN’s and CNS’s providing care in CLC’s. Currently, data are compiled for fiscal years 2004-2015. These measures were developed by Ciaran Phibbs and are now being maintained and updated by GECDAC.

Nosos – Nosos was developed by Todd Wagner as an improvement to Medicare’s hierarcical clinical conditions (HCC) used by Medicare to capitate Medicare Advantage. Nosos adds to HCC scores a battery of mental health conditions, medication classes and several other risk factors for variations in VA patient care costs. Nosos scores are available from the office of Patient Care Services (PCS). GECDAC is testing a variety of modifications to the Nosos risk score in order to improve performance primarily among the high cost VHA users. Nosos scores are provided in the Promoting GEC data. GECDAC computes Nosos scores for all Veterans for each fiscal year and for program evaluation as needed.

Care Assessment Need (CAN) Scores – CAN Scores reflect the estimated probability of admission or death within a specified time period (90 days or 1 year). Scores are expressed as a percentile, ranging from 0 (lowest risk) to 99 (highest risk) and indicate how a given Veteran compares with other individuals in terms of likelihood of hospitalization or death. These scores use VA utilization data, diagnoses, drug use and laboratory tests. CAN scores are produced on a weekly basis for Veterans receiving VA primary care in the community.