Understanding Pathways to Care for Veterans who Screen Positive for PTSD: The PTSD Access To Healthcare (PATH) Study

了解护理 PTSD 筛查呈阳性的退伍军人的途径：PTSD 获得医疗保健 (PATH) 研究

• 批准号: 10307714
• 负责人: Michelle Bovin
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10307714
• 关键词: Area; Caring; Classification; Clinic; Clinical; Communities; Consult; Data; Data Analyses; Enrollment; Ensure; Evidence based intervention; Evidence based treatment; Funding; Goals; Guidelines; Health Services Accessibility; Healthcare; Impairment; Improve Access; Individual; Intake; Intervention; Interview; Lead; Leadership; Link; Maps; Media Campaign; Medical; Mental Health; Mental disorders; Methodology; Methods; Military Personnel; Pathway interactions; Patients; Pilot Projects; Policies; Post-Traumatic Stress Disorders; Predictive Factor; Primary Health Care; Process; Provider; Quality of life; Research Design; Role; Running; Schedule; Series; Site; Structure; Suicide; Symptoms; System; Testing; Time; Veterans; Work; adverse outcome; base; data warehouse; development policy; experience; falls; follow-up; health care availability; implementation strategy; improved; innovation; insight; medical specialties; predictive modeling; response; screening

Background: Nearly half of Veterans who screen positive for PTSD in VA primary care clinics do not receive VA mental health treatment. To increase timely access to VA care, we must understand Veterans’ access pathways (the series of options offered to, and choices made by, Veterans after a positive PTSD screen that may lead them to VA care). Mapping these pathways is key to understanding who is being lost to VA care and where they are being lost. Further, by examining contextual and individual factors that predict who and where Veterans are falling off these pathways, we will be able to ascertain why these Veterans are being lost. Significance: The proposed IIR is responsive to the HSR&D priorities of both mental health and access to care and will provide insight into the impact of the MISSION Act on mental health access. At the completion of this project, we will provide three distinct deliverables: 1) guidance on where and to whom access interventions should be targeted; 2) policy and practice guidance to aid providers in linking Veterans who screen positive to effective VA care; and 3) a method for classifying Veterans from screening to VA mental health care, which could be extended to other conditions (e.g. suicidality). Innovation and Impact: Past research designed to provide information to improve access to PTSD care has been limited by focusing on the end goal (whether these Veterans do or do not access care) rather than the process by which Veterans arrive at this goal (the access pathways). The proposed project is not only one of the first to consider access to care as a process rather than an end point, it is the only study to propose examining the process of access comprehensively using a method that will generalize to the VA system as a whole, and will be applicable to other healthcare conditions identified by VA-based screening. Specific Aims: The proposed mixed methods study has the following aims: 1. Aim 1: Identify contextual- and individual-level variables that differentiate Veterans classified into a VA initial access step (an immediate response to a positive PTSD screen in primary care likely to lead to VA care; e.g., referral to PC-MHI) from those who were not, including those referred to community care via the MISSION Act. 2. Aim 2: Understand VA providers’ and patients’ experiences with, and perspectives on, why Veterans are lost to VA follow-up care immediately after screening positive for PTSD, including the role of the MISSION Act. 3. Aim 3: Map the access pathway steps hypothesized to follow each of the six initial VA access steps, as well as the step hypothesized to lead to community care provided via the MISSION Act, by leveraging the methods developed in our pilot work. Methodology: Aim 1 will include all Veterans with new PTSD screens in primary care between FY 2017-2019. Data from the VA Corporate Data Warehouse (CDW) will be used to determine Veteran access step classification and to identify contextual and individual variables that significantly predict classification. Aim 2 will use the data from Aim 1 to identify high- and low-performing sites, and qualitative interviews will be conducted with site stakeholders to understand access barriers and facilitators. Aim 3 will use quantitative data extracted from the VA CDW to map the remaining steps in the access pathways to identify which Veterans are lost to follow-up, and where. Predictive models using relevant access variables identified in Aims 1 and 2 will be run. Next Steps/Implementation: Results from the proposed IIR will inform the best ways to deploy and tailor existing access interventions (e.g. PC-MHI, direct-to-Veteran media campaigns). We will work with the Office of Primary Care to develop policy and practice guidance, and work with both the Office of Primary Care and NCPTSD leadership to disseminate guidelines and our methodology to VA primary care and PC-MHI leadership at the national level. We will begin testing implementation strategies in a subsequent IIR.

背景：在 VA 初级保健诊所中，近一半的 PTSD 筛查呈阳性的退伍军人没有接受治疗 VA 心理健康治疗。为了增加及时获得退伍军人管理局护理的机会，我们必须了解退伍军人的获得情况 路径（在积极的 PTSD 筛查后向退伍军人提供的一系列选项以及退伍军人做出的选择 可能会导致他们接受 VA 护理）。绘制这些路径对于了解哪些人正在失去退伍军人管理局护理和服务至关重要 他们正在迷失的地方。此外，通过检查预测人物和地点的背景和个人因素 退伍军人正在从这些途径中流失，我们将能够确定这些退伍军人流失的原因。 意义：拟议的 IIR 响应了 HSR&D 的心理健康和获得服务的优先事项 护理并将深入了解《使命法案》对心理健康服务的影响。完成时 在这个项目中，我们将提供三个不同的可交付成果：1）关于在何处以及向谁提供访问干预措施的指导 应该有针对性； 2) 政策和实践指导，帮助提供者将筛查呈阳性的退伍军人与 有效的 VA 护理； 3) 将退伍军人从筛选到退伍军人管理局心理健康护理进行分类的方法，该方法 可以扩展到其他条件（例如自杀）。 创新和影响：过去的研究旨在提供信息以改善获得创伤后应激障碍 (PTSD) 护理的机会 由于关注最终目标（无论这些退伍军人是否获得护理）而不是 退伍军人实现这一目标的过程（访问途径）。拟议的项目不仅是其中之一 这是第一个将获得护理视为一个过程而不是终点的研究，也是唯一提出 使用一种可推广到 VA 系统的方法来全面检查访问过程 整体，并将适用于基于 VA 的筛查确定的其他医疗保健状况。 具体目标：拟议的混合方法研究有以下目标： 1. 目标 1：确定背景和个人层面的变量，以区分退伍军人是否被归类为 VA 首字母 访问步骤（对初级保健中的阳性 PTSD 筛查做出立即反应，可能会导致 VA 护理； 例如，从那些没有转介到 PC-MHI 的人，包括那些通过社区护理转介到社区护理的人 使命法。 2. 目标 2：了解 VA 提供者和患者对退伍军人流失原因的体验和看法 在 PTSD 筛查呈阳性后立即接受 VA 后续护理，包括《使命法案》的作用。 3. 目标 3：绘制假设遵循六个初始 VA 访问步骤中每一个的访问路径步骤 作为假设的一步，通过利用《使命法案》提供社区护理 我们的试点工作中开发的方法。 方法：目标 1 将包括 2017-2019 财年初级保健中接受新 PTSD 筛查的所有退伍军人。 来自 VA 企业数据仓库 (CDW) 的数据将用于确定退伍军人访问步骤 分类并识别可显着预测分类的上下文变量和个体变量。目标2将 使用目标 1 中的数据来确定绩效高和低的站点，并将进行定性访谈 与现场利益相关者一起了解访问障碍和促进因素。目标 3 将使用提取的定量数据 从 VA CDW 绘制出通道中剩余步骤的图，以确定哪些退伍军人会丢失 后续行动以及在哪里。将运行使用目标 1 和 2 中确定的相关访问变量的预测模型。 后续步骤/实施：拟议 IIR 的结果将告知部署和定制的最佳方法 现有的访问干预措施（例如 PC-MHI、直接面向退伍军人的媒体宣传活动）。我们将与办公室合作 初级保健办公室制定政策和实践指南，并与初级保健办公室和 NCPTSD 领导层向 VA 初级保健和 PC-MHI 传播指南和我们的方法 国家层面的领导。我们将在后续的 IIR 中开始测试实施策略。