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

背景：这个CDA将提供我，梅根E。范内曼，博士，公共卫生硕士，与培训和 经验，成为一个独立的卫生服务研究人员谁应用决策科学和 信息学，以改善退伍军人获得和参与高质量的护理。为了实现这一目标，我 我将与我的导师、顾问和业务合作伙伴一起开发和评估信息， 决策支持工具，以提高退伍军人管理局领导对退伍军人管理局招生的理解和决策， 对初级和精神卫生保健的依赖（在退伍军人事务部接受的保健比例）。 意义/影响：这项研究将对退伍军人管理局领导人，退伍军人感兴趣的积极影响， 登记在VA医疗保健，退伍军人需要初级和精神卫生保健，通过增加 了解如何优化访问，质量，注册和依赖，以更好地满足退伍军人的需求。 需求随着退伍军人管理局从一个更加封闭的综合医疗保健系统转向通过网络提供护理， 包括社区合作伙伴，VA领导人需要更好地了解入学，依赖，访问， 当地设施和VISN的质量，特别是"基础服务"，如小学和精神卫生， 保健CDA与退伍军人事务部的首要任务保持高度一致-增加退伍军人的选择， VA系统，更有效地利用VA资源，提高服务的及时性。 创新：虽然我们知道大约50%的退伍军人在VA注册，大约50%的照顾这些 注册者是在VA提供的，我们几乎不了解是什么驱动这些决定，最近 分离的军人-那些参加过伊拉克和阿富汗冲突的人。初步研究 表明VA设施入组率存在很大差异，但我们没有VA变化的数据 设施依赖率。此外，我们不明白是什么导致了这些差异。虽然 对个体的一些理解（例如，年龄）和社区级别（例如，非VA供应商供应）的因素， 影响退伍军人管理局的登记和利用，我们缺乏对设施因素的了解， 适当地将退伍军人连接到VA和此后需要的服务。 具体目标：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注册率和依赖率， 初级和精神卫生保健; 2）通过评估以下因素之间的关系， 入学率、依赖率、获得护理的机会以及初级和精神卫生保健的护理质量;以及3） 开发或修改现有的信息工具，以协助机构和VISN负责人管理入组， 初级保健和精神保健的依赖率。 方法论：本CDA旨在填补对小学入学率和依赖性的理解方面的差距， 通过混合方法的精神卫生保健方法：产生关于设施登记的描述性数据 和依赖率（目标1.1）;定性研究退伍军人对他们关于入学的决定的见解 在涉及退伍军人管理局登记者和非登记者的访谈中的依赖性（目标1.2）; 他们对注册和依赖的信息需求（目标1.3）;使用分层模型来了解 关于访问和质量的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、测试和实施一种工具，以帮助退伍军人管理局领导提高入学率和依赖率 (Aim 3）。 后续步骤/实施：研究结果将帮助VA医疗保健领导层针对他们 可以管理退伍军人在VA医疗保健系统中的登记和保留，并提供所需的 基础服务。研究结果还将为我今后在信息和资源分配工具方面的工作提供参考， 支持退伍军人和领导人的决策。

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.