Short-term effects of comprehensive caregiver supports on caregiver outcomes.

To estimate the association of the Veterans Health Administration (VHA) Program of Comprehensive Assistance for Family Caregivers (PCAFC) implemented in 2011 with caregiver health and health care use. VHA claims and electronic health records from May 2009 to May 2018. Using a retrospective, pre-post study design with inverse probability of treatment weights to address selection into treatment, we examine the association of PCAFC on caregivers who are veterans: (1) outpatient primary, specialty, and mental health care visits; (2) probability of uncontrolled hypertension and anxiety/depression; and (3) VHA health care costs. We compare outcomes for caregivers approved for PCAFC (treatment) to caregivers denied PCAFC (comparison). Not applicable. In the year pre-application, we observe similar probabilities of having any VHA primary care (~36%), VHA specialty care (~24%), and VHA or VHA-purchased mental health care (~22%) for treatment and comparison caregivers. In the year post-application, treated caregivers had a 5.89 percentage point larger probability of any outpatient VHA primary care (p = 0.002) and 4.34 percentage points larger probability of any outpatient mental health care use (p = 0.014). Post-application, probabilities of having uncontrolled hypertension or diagnosed anxiety/depression were higher for both treated and comparison groups. In the second year post-application, treated caregivers had a 1.88 percentage point larger probability of uncontrolled hypertension (p = 0.019) and 4.68 percentage points larger probability of diagnosed anxiety/depression (predicted probabilities: treated = 0.30; comparison = 0.25; p = 0.005). We find no evidence of differences in VHA total costs by PCAFC status. Our findings that PCAFC enrollment is associated with increased health care diagnosis and service use may reflect improved access for previously unmet needs in the population of veteran caregivers for veterans in PCAFC. The costs and value of these increases can be weighed against other effects of the program to inform national policies supporting caregivers.

Miller KEM ，Van Houtven CH ，Kent EE ，Gilleskie D ，Holmes GM ，Smith VA ，Stearns SC ... -  《-》

Comprehensive Support for Family Caregivers: Impact on Veteran Health Care Utilization and Costs.

Van Houtven CH ，Smith VA ，Stechuchak KM ，Shepherd-Banigan M ，Hastings SN ，Maciejewski ML ，Wieland GD ，Olsen MK ，Miller KEM ，Kabat M ，Henius J ，Campbell-Kotler M ，Oddone EZ ... -  《-》

Comprehensive support of family caregivers: Are there health system cost offsets?

To examine the effect of the Department of Veterans Affairs' (VA) Program of Comprehensive Assistance for Caregivers (PCAFC) on total VA health care costs for Veterans. VA claims. Using a pre-post cohort design with nonequivalent control group, we estimated the effect of PCAFC on total VA costs up through 6 years. The treatment group included Veterans (n = 32 394) whose caregivers enrolled in PCAFC. The control group included an inverse probability of treatment weighted sample of Veterans whose caregivers were denied PCAFC enrollment (n = 38 402). May 2009-September 2017. Total VA costs pre-PCAFC application date were no different between groups. Veterans in PCAFC were estimated to have $13 227 in VA costs in the first 6 months post-PCAFC application, compared to $10 806 for controls. Estimated VA costs for both groups decreased in the first 3 years with a narrowing, but persistent and significant, difference, through 5.5 years. No significant difference in VA health care costs existed at 6 years, approximately $10 000 each, though confidence intervals reflect significant uncertainty in cost differences at 6 years. Increased costs arose from increased outpatient costs of participants. Sample composition changes may explain lack of significance in cost differences at 6 years because these costs comprise of early appliers to PCAFC. Examining 10-year costs could elucidate whether there are long-term cost offsets from increased engagement in outpatient care.

Van Houtven CH ，Smith VA ，Stechuchak KM ，Berkowitz TSZ ，Miller KEM ，Shepherd-Banigan M ，Kabat M ，Henius J ... -  《-》

Comprehensive Support for Family Caregivers of Post-9/11 Veterans Increases Veteran Utilization of Long-term Services and Supports: A Propensity Score Analysis.

Shepherd-Banigan M ，Smith VA ，Stechuchak KM ，Miller KEM ，Hastings SN ，Wieland GD ，Olsen MK ，Kabat M ，Henius J ，Campbell-Kotler M ，Van Houtven CH ... -  《-》

The Effect of Support and Training for Family Members on Access to Outpatient Services for Veterans with Posttraumatic Stress Disorder (PTSD).

Shepherd-Banigan M ，Smith VA ，Maciejewski ML ，Stechuchak KM ，Hastings SN ，Wieland GD ，Miller KEM ，Kabat M ，Henius J ，Campbell-Kotler M ，Van Houtven CH ... -  《-》