Improving access to noninstitutional long-term care for American Indian veterans.

摘要: Home-based primary care (HBPC) is an effective model of noninstitutional long-term developed in the Department Veterans Affairs (VA) to provide ongoing homebound persons. Significant rural populations American Indians have limited access services designed for frail older adults. Fourteen Medical Centers (VAMCs) initiated efforts expand HBPC concert with local tribes and Indian Health Service (IHS) facilities. This study characterizes resulting emerging models co-management. Using observational design, key respondent telephone interviews (n = 37) were conducted stakeholders representing 14 VAMCs describe these programs, evaluated relation VAMC organizational culture as revealed on annual VA All Employee Survey. Twelve independently expansion programs veterans, six different program implemented. Two unique collaborations between tribes; collaborations, retained responsibilities. used other four delivery remote areas all veteran populations, non-Indians alike. Strategies improve by reducing geographic barriers occur models. Comparing mean ratings, defined Competing Values Framework, significant group differences one Findings from this illustrate flexibility opportunities co-management healthcare non-Indians, particularly areas.