BRIEF REPORT National Structural Survey of Veterans Affairs Home-Based Primary Care Programs Jurgis Karuza, PhD,* †‡ Suzanne M. Gillespie, MD,* † Tobie Olsan, PhD, RN,* § Xeuya Cai, PhD, ¶ Stuti Dang, MD,** Orna Intrator, PhD,* †† Jiejin Li, PhD, ¶ Shan Gao, PhD, ¶ Bruce Kinosian, MD, ‡‡§§ and Thomas Edes, MD, MS ¶¶ OBJECTIVES: To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. DESIGN: We designed a national survey and surveyed HBPC program directors on-line using REDCap. PARTICIPANTS: We received 236 surveys from 394 iden- tified HBPC sites (60% response rate). MEASUREMENTS: HBPC site characteristics were quan- tified using closed-ended formats. RESULTS: HBPC program directors were most often reg- istered nurses, and HBPC programs primarily served veter- ans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practi- tioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and commu- nity-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). CONCLUSION: HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive pri- mary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteris- tics and care models are related to the processes and out- comes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of ceterans. J Am Geriatr Soc 2017. Key words: home-based primary care I n the 1970s, the Department of Veterans Affairs (VA) spearheaded the Hospital-Based Home Care program at six sites that emphasized noninstitutional, extended reha- bilitation programs. 1 It evolved, becoming the Home- Based Primary Care (HBPC) program that includes nearly 400 sites serving 53,000 veterans, who are largely male (96%) older adults (mean age 76.5). 2 Although seemingly similar to Medicare home health agencies, VA HBPC is different. Aside from exclusively serving veterans, it pri- marily targets those with complex chronic illness and pro- vides longitudinal, comprehensive primary care using interdisciplinary teams. 2 In contrast, home health agencies typically provide problem-focused, episodic, postacute care by non-team-based providers to older adults with short- term remediable conditions. 2 Several studies have found evidence of the effectiveness of HBPC within and outside of VA, including fewer hospitalizations and lower cost. 3–10 VA HBPCs are organized hierarchically. Each VA Medical Center has a HBPC parent program headed by a program director that provides programmatic administra- tive oversight. Under each parent program, there is one or more HBPC sites. Typically, the parent program hosts a HBPC site. Often, there is one or more additional sites that administratively reports to the parent program’s pro- gram director but typically is located in a separate From the *Canandaigua Veterans Affairs Medical Center, Canandaigua; † Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester; ‡ Department of Psychology, State University of New York at Buffalo State, Buffalo; § School of Nursing; ¶ Department of Biostatistics, University of Rochester, Rochester, New York; **Miami Veterans Affairs Healthcare System, Miami, Florida; †† Public Health Sciences, University of Rochester, Rochester, New York; ‡‡ Division of Geriatrics, School of Medicine, University of Pennsylvania; §§ Geriatrics and Extended Care Data Analysis Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania; and ¶¶ Geriatrics and Extended Care, Office of Clinical Operations and Management, U.S. Department of Veterans Affairs, Washington, District of Columbia. Address correspondence to Jurgis Karuza, Division of Geriatrics, University of Rochester, 435 East Henrietta Road, Rochester, NY 14620. E-mail: jurgis_karuza@urmc.rochester.edu DOI: 10.1111/jgs.15126 JAGS 2017 Published 2017. This article is a U.S. Government work and is in the public domain in the USA 0002-8614/17/$15.00