Access to and Choice of VA or Non-VA Health Care by Veterans of Recent Conflicts

近期冲突退伍军人获得和选择 VA 或非 VA 医疗保健的机会

• 批准号: 10415826
• 负责人: Megan Enfield Vanneman
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10415826
• 关键词: Address; Affordable Care Act; Afghanistan; Age; Caring; Communities; Conflict (Psychology); Country; Data; Decision Making; Doctor of Philosophy; Enrollment; Ensure; Facility Accesses; Feedback; Foundations; Future; Goals; Health Services; Health Services Accessibility; Healthcare; Healthcare Systems; Individual; Informatics; Integrated Health Care Systems; Interview; Iraq; Leadership; Learning; Letters; Measures; Medicaid; Medical center; Mental Health; Mental Health Services; Mentors; Methodology; Methods; Military Personnel; Modeling; Modernization; Pattern; Performance; Population; Primary Health Care; Provider; Quality of Care; Research; Research Personnel; Resource Allocation; Resources; Sampling; Science; Services; Statistical Models; System; Telephone Interviews; Testing; Time; Training; Variant; Veterans; Wait Time; Work; community-level factor; dashboard; experience; implementation study; impression; improved; innovation; insight; interest; peer; pilot test; satisfaction; support tools; tool; usability; web site

Background: This CDA will provide me, Megan E. Vanneman, PhD, MPH, with the training and experience to become an independent health services researcher who applies decision science and informatics to improve Veterans’ access to and engagement in high-quality care. To help achieve this goal, I will work with my mentors, consultants, and operational partners to develop and evaluate an information and decision support tool to improve VA leaders’ understanding and decision-making about VA enrollment and reliance (proportion of care received at VA) on primary and mental health care. Significance/Impact: This research will have a positive impact on VA leaders, Veterans interested in enrolling in VA health care, and Veterans needing primary and mental health care, by increasing understanding of how access, quality, enrollment, and reliance can be optimized to better meet Veterans’ needs. As the VA moves from a more closed, integrated healthcare system to providing care through networks that include community partners, VA leaders need to better understand enrollment, reliance, access, and quality at their local facilities and VISNs, particularly for “foundational services,” such as primary and mental health care. The CDA strongly aligns with top VA priorities – increasing choice for Veterans, modernizing the VA system, using VA resources more efficiently, and improving timeliness of services. Innovation: While we know that about 50% of Veterans enroll in VA and that about 50% of care for these enrollees is provided in the VA, we have little understanding of what drives these decisions for recently separated Servicemembers – those who participated in conflicts in Iraq and Afghanistan. Preliminary studies show that there is wide variation in VA facility enrollment rates, but we do not have data on variation in VA facility reliance rates. Furthermore, we do not understand what drives these differences. Although there is some understanding of individual (e.g., age) and community-level (e.g., non-VA provider supply) factors that influence VA enrollment and utilization, we lack understanding of facility factors that can be modified to appropriately connect Veterans to VA and needed services thereafter. Specific Aims: The research plan has three primary goals: 1) Learn what information and resources VA facility and VISN leaders need to better understand and manage enrollment rates and reliance rates for primary and mental health care; 2) Derive insights on facility factors by evaluating relationships among enrollment rates, reliance rates, access to care, and quality of care for primary and mental health care; and 3) Develop or modify existing information tool(s) to assist facility and VISN leaders to manage enrollment and reliance rates for primary and mental health care. Methodology: This CDA seeks to fill the gap in understanding on enrollment and reliance for primary and mental health care through a mixed-methods approach by: producing descriptive data on facility enrollment and reliance rates (Aim 1.1); qualitatively studying Veterans’ insights on their decisions regarding enrollment and reliance in interviews involving VA enrollees and non-enrollees (Aim 1.2); interviewing VA leaders about their information needs regarding enrollment and reliance (Aim 1.3); using hierarchical modeling to understand what modifiable facility factors on access and quality are associated with enrollment and reliance rates (Aim 2); and developing, testing, and implementing a tool to assist VA leaders to improve enrollment and reliance rates (Aim 3). Next Steps/Implementation: Study results will help VA healthcare leadership target changes that they can make to manage enrollment and retention of Veterans in the VA healthcare system and deliver needed foundational services. Results will also inform my future work on information and resource allocation tools to support Veterans’ and leaders’ decision making.

背景：本 CDA 将为我，Megan E. Vanneman，博士，公共卫生硕士，提供培训和 成为一名独立的卫生服务研究员，应用决策科学和 信息学，以改善退伍军人获得和参与高质量护理的机会。为了帮助实现这一目标，我 将与我的导师、顾问和运营合作伙伴一起开发和评估信息和 决策支持工具，以提高 VA 领导者对 VA 招生和决策的理解和决策 对初级卫生保健和精神卫生保健的依赖（在退伍军人管理局接受的护理的比例）。 意义/影响：这项研究将对退伍军人管理局领导人、感兴趣的退伍军人产生积极影响 参加 VA 医疗保健以及需要初级和心理保健的退伍军人，通过增加 了解如何优化准入、质量、注册和信赖，以更好地满足退伍军人的需求 需要。随着退伍军人管理局从更加封闭、综合的医疗保健系统转向通过网络提供护理 包括社区合作伙伴在内，VA 领导者需要更好地了解入学、依赖、获取和 当地设施和 VISN 的质量，特别是“基础服务”，例如小学和心理服务 卫生保健。 CDA 与 VA 的首要任务高度一致——增加退伍军人的选择，实现现代化 VA系统，更高效地利用VA资源，提高服务时效性。 创新：虽然我们知道大约 50% 的退伍军人参加了 VA，并且大约 50% 的人为这些人提供护理 VA 中提供了参与者，我们对最近推动这些决定的因素知之甚少 失散军人——参与伊拉克和阿富汗冲突的军人。初步研究 显示 VA 机构的入学率存在很大差异，但我们没有 VA 差异的数据 设施依赖率。此外，我们不明白是什么导致了这些差异。虽然有 对个人（例如年龄）和社区层面（例如非 VA 提供者供应）因素的一些了解 影响 VA 入学和利用，我们缺乏对可以修改的设施因素的了解 适当地将退伍军人与 VA 联系起来，并提供此后所需的服务。 具体目标：该研究计划有三个主要目标：1）了解 VA 的信息和资源 设施和 VISN 领导者需要更好地了解和管理入学率和依赖率 初级保健和精神保健； 2) 通过评估设施因素之间的关系来深入了解设施因素 初级卫生保健和精神卫生保健的入学率、依赖率、获得护理的机会以及护理质量；和 3) 开发或修改现有信息工具，以协助设施和 VISN 领导者管理注册和 对初级卫生保健和精神卫生保健的依赖率。 方法：本 CDA 旨在填补对小学和小学入学和依赖的理解空白。 通过混合方法提供精神卫生保健： 生成有关机构登记的描述性数据 和信赖率（目标 1.1）；定性研究退伍军人对其入学决策的见解 以及对涉及 VA 登记者和非登记者的访谈的依赖（目标 1.2）；采访 VA 领导 他们对注册和信赖的信息需求（目标 1.3）；使用层次模型来理解 哪些可修改的设施因素与入学率和依赖率相关（目标 2）； 开发、测试和实施工具来协助 VA 领导者提高入学率和信赖率 （目标 3）。 后续步骤/实施：研究结果将帮助 VA 医疗保健领导层实现他们所期望的变革 可以管理 VA 医疗保健系统中退伍军人的注册和保留，并提供所需的服务 基础服务。结果还将为我未来在信息和资源分配工具方面的工作提供信息 支持退伍军人和领导人的决策。