Impact of Combined Recovery Program and Home Telehealth Among Veterans with substance use disorders in the VA Inpatient Setting

联合康复计划和家庭远程医疗对退伍军人管理局住院患者中患有药物滥用障碍的退伍军人的影响

• 批准号: 10316716
• 负责人: ELIZABETH J SANTA ANA
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 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 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10316716
• 关键词: Address; Admission activity; Aftercare; Age; Alcohols; Ambulatory Care; Area; Behavior; COVID-19 pandemic; Care given by nurses; Caring; Cellular Phone; Chronic; Communities; Community Integration; Data; Data Analyses; Development; Devices; Diagnosis; Drug Use Disorder; Effectiveness; Eligibility Determination; Emergency department visit; Evaluation; Event; Exhibits; Frequencies; Future; Goals; Health; Health Benefit; Health Services Accessibility; Healthcare; Healthcare Systems; Home; Homelessness; Hospitalization; Hospitals; Housing; Impairment; Inpatients; Intervention; Interview; Life; Maintenance; Measures; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; Monitor; Nicotine Dependence; Nurses; Occupational; Outcome; Outpatients; Participant; Patients; Performance; Phase; Population; Procedures; Process; Psychiatric therapeutic procedure; Quality of life; Randomized; Recommendation; Recovery; Relapse; Reporting; Research Personnel; Research Priority; Self Management; Services; Social Functioning; Substance Use Disorder; Suicide; Technology; Time; Training; Veterans; arm; community engagement; comorbidity; cost; design; follow-up; handbook; health care service; high risk; hospital readmission; housing instability; illicit drug use; implementation intervention; improved; innovation; inpatient psychiatric settings; inpatient service; meetings; motivational enhancement therapy; multimodality; novel; patient engagement; patient response; preservation; primary outcome; programs; readmission rates; recruit; reduced substance use; relative effectiveness; secondary outcome; service gap; service utilization; skills; skills training; social; substance use; substance use treatment; suicidal risk; telehealth; treatment arm; treatment as usual; treatment effect; web app

Justification: High inpatient readmissions among Veterans with SUDs constitutes a costly and persistent healthcare problem. VHA Handbook 1160.06 guides the development and implementation of recovery-oriented mental health (MH) services, although significant service gaps remain on VA inpatient settings. ‘Combined Recovery Program (CRP)’ is designed to address these gaps by enhancing stabilization of Veterans with SUDs beyond hospital discharge and consists of ‘Group Motivational Interviewing’, an adaptation of motivational interviewing; and ‘Life Skills for Housing Maintenance’, involving skills training for enhancing housing stability. To be added to CRP, Stable & Able (S&A) is a VA Home Telehealth (HT) nurse-monitored program providing assessment and self-management skills in the post-hospitalization phase. Gaps Addressed: This proposal addresses VA research priorities: access to care and MH, benefitting Veterans with SUDs. A significant proportion of these Veterans exhibit homelessness and suicidality. Study objectives address SAIL MH Composite measures ‘PDE1’ to increase Post-Discharge Treatment Engagement in MH care; and ‘HRF7’ to increase care processes for Veterans at high risk for suicide. During the COVID-19 pandemic, telehealth solutions offer safe treatment options as well as reduce isolation. Innovativeness: This proposal is consistent with 2018 MISSION Act in priority areas: mental illness, SUD, and housing instability via a technology-enabled format and through addressing gaps in the current inpatient recovery model involving limited availability of staff training in and availability of recovery-oriented services. CRP and S&A present innovative/novel interventions ready for deployment. Both CRP and S&A were designed specifically to assist high risk Veterans with SUDs to remain stably housed. S&A is conveniently provided via App using an iPad, cell phone, or the Medtronic Commander Flex and allows 3 mos. of daily monitoring by trained HT staff. Specific Aim I: Assess the relative effects of Treatment Engagement and Substance Use [and SUD-related problems] between CRP+S&A vs. CRP and CRP+S&A vs. TAU by 3-mos follow-up. Primary Hypothesis 1a: Treatment Engagement: Participants in CRP + S&A will attend more outpatient SUD treatment sessions and general MH treatment sessions compared to participants in CRP and to TAU. Primary Hypothesis 1b: Substance Use: Participants in CRP + S&A will lower quantity and frequency of substance use and SUD-related problems compared to participants in CRP and to TAU. Secondary Hypothesis 1c: Preventable Services: Participants in CRP + S&A will reduce Preventable Healthcare Services (hospital readmissions and ED visits) compared to participants in CRP and to TAU. Secondary Hypothesis 1d: Participants in CRP + S&A will report Greater QoL; # of Days Living in Stable Housing; and # of Days Engaging in Community Events and/or Activities compared to CRP and to TAU. Specific Aim II: Conduct Veteran participant thematic interviews and Staff ‘focus’ interviews to assess qualitative facilitators and barriers to implementation. Project Methods: 195 Veterans with SUDs in the Charleston VAMC inpatient setting will be recruited. Participants will be randomly assigned to: (1) CRP + S&A; (2) CRP; and (3) TAU. Participants will be followed- up at 1 and 3-months and data analyzed using mixed methods. Investigators of this project plan to evaluate implementation of the interventions proposed in other VA inpatient programs within the VISN through future implementation projects and will utilize study findings in partnership for improving SAIL performance measures. Description of Primary Outcomes: A. Treatment Engagement (measured in SUD and general MH treatment sessions attended); B. Substance Use (measured in quantity and frequency) and SUD-related problems. Secondary outcomes: C. Preventable Services (measured in hospital readmissions and ED visits) and D. Quality of Life, #Days Living in Stable Housing, and # Days Engaging in Community Events and/or Activities.

理由：患有肥胖症的退伍军人的高再住院率构成了一种昂贵和持久的 医疗保健问题。VHA手册1160.06指导以恢复为导向的发展和实施 精神健康(MH)服务，尽管退伍军人医院的住院设置仍然存在显著的服务缺口。‘组合 恢复计划(CRP)旨在通过使用SUDS增强退伍军人的稳定性来解决这些差距 除出院外，还包括对动机的改编--“团体动机访谈” 以及《住房维修的生活技能》，其中包括提高住房稳定性的技能培训。 将被添加到CRP，稳定和能力(S和A)是一个退伍军人家庭远程健康(HT)护士监控计划，提供 住院后阶段的评估和自我管理技能。 解决差距：本提案涉及退伍军人研究的优先事项：获得护理和卫生保健，使退伍军人受益 加了肥皂水。这些退伍军人中有相当一部分表现出无家可归和自杀倾向。研究目标 地址SAIL MH综合措施‘PDE1’，以增加MH护理中的出院后治疗参与度； 和‘HRF7’，增加对自杀高危退伍军人的护理流程。新冠肺炎大流行期间， 远程医疗解决方案提供安全的治疗选项，并减少隔离。 创新性：该提案与2018年《使命法案》在优先领域一致：精神疾病、SUD和 通过技术支持的形式和通过解决当前住院患者恢复中的差距来实现住房不稳定 这一模式涉及有限的工作人员培训和面向恢复的服务的可用性。C-P和S&A 提出可供部署的创新/新颖干预措施。CRP和S律师事务所都是专门为 用肥皂水帮助高危退伍军人保持稳定的住房。S&A通过应用提供，使用 IPad、手机或美敦力指挥官Flex，并允许3个月。由训练有素的HT工作人员进行日常监测。 具体目标一：评估治疗参与和物质使用的相对效果[和与可持续发展相关的 [问题]C-反应蛋白+S A与C-反应蛋白和C-反应蛋白+S&A与TAU的3个月随访。 基本假设1a：治疗参与度：C反应蛋白+S和A组的参与者将参加更多的门诊SUD 治疗疗程和一般MH治疗疗程与CRP组和TAU组参与者的比较。 基本假设1b：物质使用：C反应蛋白+S&A组的参与者将降低 与CRP和TAU参与者的物质使用和SUD相关问题进行比较。 次要假设1c：可预防服务：C反应蛋白+S&A的参与者将减少可预防服务 医疗服务(再次住院和急诊科就诊)与CRP和TAU参与者的比较。 次级假设1D：C反应蛋白+S和A组的参与者将报告更高的生活质量；稳定生活的天数 住房；参与社区活动和/或活动的天数，与社区发展计划和TAU相比。 具体目标二：开展资深参与者专题访谈和工作人员“焦点”访谈，以评估定性 推动者和执行障碍。 项目方法：将招募195名在查尔斯顿VAMC住院环境中患有肥胖症的退伍军人。 参与者将被随机分配到：(1)C-P+S和A；(2)C-P；和(3)TAU。参赛者将被跟踪- 在1个月和3个月时，使用混合方法分析数据。该项目的调查人员计划评估 VISN内其他退伍军人医院住院方案中建议的干预措施的实施情况 实施项目，并将利用研究结果与伙伴合作，改进SAIL性能衡量标准。 主要结果说明：a.治疗参与度(以SUD和一般MH治疗衡量 (B)药物使用(以数量和频率衡量)和与可持续发展有关的问题。 次要结果：C.可预防服务(通过重新入院和急诊室就诊来衡量)和D.质量 有#天生活，#天住在稳定的住房，#天参加社区活动和/或活动。