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As the nation’s largest integrated healthcare system, the Veterans Health Administration (VHA) is faced with challenges in caring for a growing number of older adult Veterans with comorbid medical, mental health, neurocognitive, and behavioral care needs. These Veterans can pose significant risk of harm to self or others and can lead to inefficient, ineffective, or inappropriate use of VHA resources. Using an implementation science framework, this presentation will describe the development and expansion of the Care of Patients with Complex Problems (CP)^2 Program, outcomes, and implications. A national needs assessment of 138 VHA medical centers estimated 42% of inpatient beds are occupied by Veterans with complex problems, with 38% indicating access to inpatient care related challenges. Through leadership feedback and group consensus, an interdisciplinary task force and a VHA senior leadership steering committee selected one of six promising practices to launch the (CP)^2 Program. The key components of the program include: dissemination of promising practices; a national learning collaborative and webinar series (participation averaging 200 staff/month); and centralized technical assistance. Three medical centers were invited to participate in the initial launch of the program with a regional dissemination of the promising practice model that supports transitioning Veterans from inpatient care to more appropriate and less costly community settings. Following promising outcomes (i.e. reductions in costs and hospital readmissions) and over 30 briefings/stakeholder meetings, support was garnered for a national training and expanded dissemination of the model. Implications for practice, development of VHA/community partnerships, and lessons learned were identified.

The impact of STAR-VA on psychotropic drug use among residents with behavioral symptoms of dementia was evaluated through a difference-in-differences framework. STAR-VA residents enrolled 2013-2017 were evaluated longitudinally pre-post intervention. The primary outcome was the number of as needed administrations with an indication of ‘anxiety’ or ‘agitation’. The analytical cohort included 214 training cases and 1,870 controls from untrained sites meeting eligibility criteria. STAR-VA cases were less white (48% vs. 54%), less black (11% vs. 14%), and had significantly longer median length of stay (830 vs. 261 days), respectively. STAR-VA cases had on average 3.5 as needed doses/month of psychotropic medication before the intervention and 1.7 after, controls averaged 1.8 doses/month. After adjustment for person-time-fixed effects, enrollment was associated with 55% (95% CI:30, 68) reduction or an average 0.8 as needed psychotropic doses/month. Findings demonstrate effectiveness in decreasing as-needed psychotropic drug use among CLC residents, supporting continued implementation of STAR-VA.