Quality of Care for Justice-Involved Veterans: Gaps, Predictors, and Stakeholder-Driven Solutions

参与司法的退伍军人的护理质量：差距、预测因素和利益相关者驱动的解决方案

• 批准号: 10186533
• 负责人: Andrea K Finlay
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186533
• 关键词: Address; Automobile Driving; Behavioral Model; Caring; Characteristics; Code; Colorectal Cancer; Complex; Consolidated Framework for Implementation Research; Continuity of Patient Care; Criminal Justice; Data; Data Collection; Emotional; Foundations; Fright; Future; General Population; Goals; HIV; Health; Health Services Accessibility; Health system; Healthcare Systems; Hearing; Hepatitis C; Homelessness; Hospitalization; Hypertension; Individual; Interview; Justice; Measures; Medical; Mental Health; Mental Health Services; Mental disorders; Methods; Morbidity - disease rate; Nature; Patients; Pattern; Perception; Pharmaceutical Preparations; Policies; Population; Process; Provider; Psychosocial Influences; Quality of Care; Research; Research Personnel; Resources; Risk; Risk Factors; Site; Structure; Substance Use Disorder; Supervision; System; Trust; Variant; Veterans; Vulnerable Populations; Work; addiction; administrative database; care seeking; care systems; clinical encounter; comorbidity; contextual factors; demographics; experience; improved; informant; medical specialties; military veteran; mortality; mortality risk; operation; outreach; outreach program; programs; provider factors; residence; secondary analysis; social; social stigma; unconscious bias

Background: Justice-involved Veterans – military Veterans detained by or under the supervision of the criminal justice system – have an excess burden of mental health and medical morbidity, as well as elevated mortality risk compared to the general and Veteran populations. Despite high rates of use of mental health and substance use disorder treatment, justice-involved Veterans are at risk for receiving lower quality mental health and addiction treatment. Furthermore, the quality of their medical care has never been examined despite their heightened risk for disparities. By examining patterns in quality of care, identifying patient, provider, and health system factors related to high and low quality of care, and hearing from justice-involved Veterans and VA staff about barriers to and facilitators of high quality care, we can develop new quality improvement initiatives to improve care for this vulnerable population. Objectives: Specific aims are to: (1) Determine whether justice-involvement is an independent risk factor for poor care quality; (2) Identify predictors of care quality among justice-involved Veterans; and (3) Evaluate Veterans' and other stakeholders' perceptions of factors that explain variation in quality of care. Methods: The proposal project is guided by the Behavioral Model for Vulnerable Populations. Aim 1 uses existing VHA administrative databases and established process quality measures to examine whether being justice-involved is independently associated with lower quality of care. We will focus on major causes of morbidity and mortality in this population, including substance use disorders, mental health disorders, hypertension, hepatitis C, HIV, and colorectal cancer. Aim 2 uses existing VHA administrative databases to identify predictors of high or low quality of care among justice-involved Veterans. Secondary analyses will examine a subset of Veterans who have more detailed data collected during justice outreach. In Aim 3, we will conduct 80 qualitative interviews total with justice-involved Veterans and VHA justice outreach staff, clinicians, and managers. The Consolidated Framework for Implementation Research will guide qualitative data collection, coding and analysis. Summary: This study will serve as the foundation for future studies that address barriers to and implement drivers of high quality care across VHA facilities. Accomplishing these aims will help us understand and improve the quality of care received by some of our most vulnerable Veterans, improve their health, and decrease their risks for hospitalizations and mortality.

背景：涉司法退伍军人-军人退伍军人被拘留或根据

项目成果

Legal System Involvement and Opioid-Related Overdose Mortality in U.S. Department of Veterans Affairs Patients.

• DOI: 10.1016/j.amepre.2021.06.014
• 发表时间: 2022-01
• 期刊: American journal of preventive medicine
• 影响因子: 5.5
• 作者: Finlay AK;Palframan KM;Stimmel M;McCarthy JF
• 通讯作者: McCarthy JF

Expanding the Scope of Forensic and Other Services for Justice-Involved Veterans.

• DOI: 10.29158/jaapl.210047-21
• 发表时间: 2022-03
• 期刊: The journal of the American Academy of Psychiatry and the Law
• 作者: Rosenthal J;Finlay AK
• 通讯作者: Finlay AK