Assessing Trends in STI Screening among Women Veterans in the VHA

背景：性传播感染（STI），特别是淋病和衣原体的发病率， 在过去十年中急剧增加。有几个因素使女性退伍军人面临更高的性传播感染风险 与非退伍军人妇女和男性退伍军人相比， 暴力（包括军事性创伤），亲密伴侣暴力，以及与之相关的不安全行为 创伤后压力和相关物质的使用。妇女也更容易受到性传播感染的影响， 可能无症状，未被发现，并导致并发症。指南推荐的STI筛查可以 检测感染和减少负面结果，但筛查未得到充分利用。 重要性/影响：妇女保健和初级保健是弗吉尼亚州/难民署确定的优先领域， 第1330.01号指令规定，设施必须为退伍军人管理局妇女提供性传播感染筛查和咨询。 保健和初级保健诊所。然而，VA的筛查方案没有得到很好的实施， 筛查率不理想。为了改善筛查和结果，有必要了解当前的 性病筛查的前景。 创新：这项研究具有创新性，因为它关注的是一个非常普遍但研究不足的问题 这对妇女的功能和福祉起着关键作用。很少有研究调查流行病学 没有人评估过卫生系统对性传播感染的反应，也没有人研究过 在患者、提供者或实践特征方面，女性退伍军人的性传播感染筛查率。此外，本发明还 目前对提供者进行性传播感染筛查的结构或信息支持很少。 具体目标：使用管理数据来检查实践，提供者和患者水平的相关性， 淋病和衣原体筛查在VA（目标1）;使用定性访谈，以探讨实践，提供者， 和患者层面的障碍和促进因素，以性病筛查在弗吉尼亚州妇女的健康和初级保健诊所（目的 2）;并使用以用户为中心的设计原则，开发多管齐下的临床决策支持工具， 改善妇女淋病和衣原体检查 在退伍军人事务部设施进行测试，以评估吸收、可用性和覆盖范围（目标3）。 方法：采用目标1和目标2中的混合方法，采用定量电子健康记录 分析和随后的定性访谈，这一拟议的CDA将审查筛选的相关性， 探讨从患者和提供者两方面对女性退伍军人进行性传播感染筛查的障碍和促进因素 perspective.这些发现将通知目标3，临床决策支持工具的开发， 以用户为中心的设计，这是一种参与式方法，包含了多轮利益相关者的反馈。的 临床决策支持工具将提醒提供者淋病和衣原体筛查需求，支持性 病史采集和记录，提高对筛查指南的认识，以加强STI管理 女性患者的治疗方案最终的工具将在两个VISN 4设施的小型可行性试点中进行测试， 评估吸收、可用性和覆盖范围。 后续步骤/实施：本研究的结果将通过HSR&D验证器启动的 研究（IIR）的建议，在第3年检查妇女退伍军人的使用非VA护理GC/CT，并告知 IIR建议在第5年进行有效性实施试验，以在多个VA测试决策支持工具 网站.

Background: Rates of sexually transmitted infection (STI), especially gonorrhea and chlamydia, have increased dramatically over the past decade. Several factors put women Veterans at higher risk for STIs compared with both non-Veteran women and male Veterans, including substantial rates of exposure to sexual violence (including military sexual trauma), intimate partner violence, and unsafe behavior associated with posttraumatic stress and related substance use. Women are also more vulnerable to STI effects, as infection may be asymptomatic, undetected, and lead to complications. Guideline-recommended STI screening can detect infection and mitigate negative outcomes, but screening is underutilized. Significance/Impact: Women’s health and primary care are priority areas identified by VA/ORD, and the VA Directive 1330.01 states that facilities are required to provide STI screening and counseling in VA women’s health and primary care clinics. However, screening protocols across VA are not well-implemented and screening rates are suboptimal. To improve screening and outcomes, it is necessary to understand the current landscape of STI screening in VA. Innovation: The study is topically innovative because it focuses on a very prevalent but understudied issue that plays a critical role in women’s functioning and well-being. Few studies have examined the epidemiology of STIs in women Veterans and none has assessed health system responses to STIs or examined patterns in rates of STI screening among women Veterans across patient, provider or practice characteristics. Further, there is currently very little structural or informational support for providers screening for STIs. Specific Aims: Use administrative data to examine practice-, provider-, and patient-level correlates of gonorrhea and chlamydia screening in VA (Aim 1); use qualitative interviews to explore practice-, provider-, and patient-level barriers and facilitators to STI screening in VA women’s health and primary care clinics (Aim 2); and use principles of user-centered design to develop a multi-pronged clinical decision support tool to improve gonorrhea and chlamydia screening for women Veterans in women’s health and primary care and pilot test it at VA facilities to assess uptake, usability, and reach (Aim 3). Methodology: With a mixed-methods approach in Aims 1 & 2, employing quantitative electronic health record analyses and subsequent qualitative interviews, this proposed CDA will examine correlates of screening and explore barriers and facilitators to STI screening among women Veterans from both a patient and provider perspective. These findings will inform Aim 3, the development of a clinical decision support tool employing user-centered design, a participatory approach that incorporates multiple rounds of stakeholder feedback. The clinical decision support tool will alert providers to gonorrhea and chlamydia screening needs, support sexual history-taking and documentation, and raise awareness of screening guidelines to enhance STI management for women patients across VA. The final tool will be tested in a small feasibility pilot at two VISN 4 facilities to assess uptake, usability, and reach. Next Steps/ Implementation: Findings from this study will be augmented by an HSR&D investigator-initiated research (IIR) proposal in Year 3 to examine women Veteran’s use of non-VA care for GC/CT and inform an IIR proposal in Year 5 for an effectiveness-implementation trial to test the decision support tool at multiple VA sites.