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

背景：涉及司法的退伍军人-被拘留或被拘留的退伍军人 刑事司法系统的监督-心理健康负担过重， 医疗发病率，以及与一般和 退伍军人群体。尽管精神卫生和药物使用率很高， 疾病治疗，涉及司法的退伍军人面临接受低质量治疗的风险 心理健康和戒毒治疗。此外，他们的医疗保健质量 尽管它们的不平等风险很高，但从未得到过审查。通过检查 护理质量模式，识别患者、提供者和卫生系统相关因素 高质量和低质量的护理，并听取司法参与退伍军人和退伍军人事务部工作人员的意见 关于高质量护理的障碍和促进因素，我们可以开发新的质量 改善对这一弱势群体的照顾。 目的：具体目标是：（1）确定司法介入是否是一种 护理质量差的独立风险因素;（2）确定护理质量的预测因素 （3）评价退伍军人和其他利益相关者的 对解释护理质量变化的因素的看法。 方法：以弱势群体行为模式为指导， 人口。目标1使用现有的VHA行政数据库， 过程质量的措施，以检查是否被公正参与是独立的 与较低的护理质量有关。我们将重点关注发病的主要原因， 这一人群的死亡率，包括药物使用障碍、精神健康障碍， 高血压、丙型肝炎、艾滋病和结肠直肠癌。目标2使用现有VHA 管理数据库，以确定高或低质量的护理之间的预测 参与正义的退伍军人二次分析将检查退伍军人的一个子集， 在司法外联期间收集更详细的数据。在目标3中，我们将进行80 定性访谈总与司法参与退伍军人和VHA司法外展工作人员， 临床医生和管理人员。实施研究综合框架 将指导定性数据的收集、编码和分析。 总结：本研究将作为未来研究的基础， 在VHA设施中实施高质量护理的障碍和驱动因素。 实现这些目标将有助于我们了解和提高护理质量 我们的一些最脆弱的退伍军人接受，改善他们的健康，并减少 他们住院和死亡的风险。

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.