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

BACKGROUND: As 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. METHODS: This 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. RESULTS: VA‐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. CONCLUSIONS: The 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.