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：涉及正义的退伍军人 - 由或之下创立的退伍军人 对刑事司法系统的监督 - 精神健康过多的烧伤和 与一般和一般和 退伍军人人口。尽管精神健康和使用物质的使用率很高 疾病治疗，涉及正义的退伍军人有质量较低的风险 心理健康和成瘾治疗。此外，他们的医疗质量 尽管差异风险增加了，但从未被检查过。通过检查 护理质量的模式，识别患者，提供者和卫生系统因素相关的模式 高质量和低质量的护理，并听取涉及正义的退伍军人和VA员工的聆听 关于高质量护理的障碍和促进者，我们可以发展新的质量 改善对这一脆弱人群的护理的改进计划。 目的：具体目的是：（1）确定司法参与是否是 不良护理质量的独立风险因素； （2）确定护理质量的预测指标 在涉及正义的退伍军人中； （3）评估退伍军人和其他利益相关者” 对解释护理质量变化的因素的看法。 方法：提案项目以易受伤害的行为模型为指导 人群。 AIM 1使用现有的VHA管理数据库并建立 流程质量措施检查是否独立涉及正义 与较低的护理质量有关。我们将专注于发病率和 该人群的死亡率，包括药物使用障碍，心理健康障碍， 高血压，丙型肝炎，HIV和结直肠癌。 AIM 2使用现有VHA 管理数据库，以识别高质量护理质量的预测指标 涉及正义的退伍军人。次要分析将检查一部分退伍军人 在司法外展期间收集了更多详细的数据。在AIM 3中，我们将进行80 与诉讼的退伍军人和VHA司法外展员工进行的定性访谈， 临床医生和经理。实施研究的合并框架 将指导定性数据收集，编码和分析。 摘要：这项研究将成为未来研究的基础 跨VHA设施的高质量护理驱动因素的障碍。 实现这些目标将有助于我们理解和提高护理质量 由我们一些最脆弱的退伍军人收到，改善健康状况并减少 他们的住院和死亡率风险。

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