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感染的比率 在过去的十年里急剧增加。几个因素使退伍军人面临更高的性传播感染风险 与非退伍军人和男性退伍军人相比，包括接触性行为的比例很高 暴力(包括军中性创伤)、亲密伴侣暴力和与以下有关的不安全行为 创伤后应激和相关物质的使用。女性也更容易受到性传播感染的影响，因为感染 可能无症状，未被发现，并导致并发症。指南建议的性传播感染筛查可以 检测感染并减轻负面结果，但筛查没有得到充分利用。 意义/影响：妇女健康和初级保健是退伍军人事务部和退伍军人事务部确定的优先领域 1330.01号指令规定，需要设施来为退伍军人事务部妇女提供性传播感染筛查和咨询 卫生和初级保健诊所。然而，整个退伍军人管理局的筛查方案没有得到很好的实施，而且 筛查率并不理想。为了改善筛查和结果，有必要了解目前的 退伍军人事务部性传播感染筛查现状。 创新：这项研究在主题上具有创新性，因为它关注的是一个非常普遍但研究不足的问题 这对妇女的运作和福祉起着至关重要的作用。很少有研究对流行病学进行考察。 没有人评估卫生系统对性传播感染的反应或检查#年的模式 女性退伍军人中不同患者、提供者或执业特征的性传播感染筛查率。此外， 目前，对提供者筛查性传播感染的结构性或信息性支持很少。 具体目标：使用管理数据检查实践级别、提供者级别和患者级别的关联 在退伍军人事务部进行淋病和衣原体筛查(目标1)；使用定性访谈来探索实践-，提供者-， 以及退伍军人事务部妇女健康和初级保健诊所性传播感染筛查的患者一级障碍和促进者(AIM 2)；运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 提高退伍军人女性淋病和衣原体筛查的妇女保健和初级保健试点 在退伍军人管理局进行测试，以评估其接受度、可用性和覆盖范围(目标3)。 方法：在目标1和目标2中采用混合方法，使用量化电子健康记录 分析和随后的定性访谈，这项拟议的CDA将审查筛查和 探索女性退伍军人性传播感染筛查的障碍和促进者 透视。这些发现将为Aim 3，一个临床决策支持工具的开发提供信息，该工具使用 以用户为中心的设计，这是一种参与式方法，融合了多轮利益相关者反馈。这个 临床决策支持工具将提醒提供者淋病和衣原体筛查需求，支持性行为 记录病历和记录，并提高对筛查指南的认识，以加强性传播感染管理 为退伍军人事务部的女性患者准备的。最终工具将在两个VISN 4设施的小型可行性试验中进行测试，以 评估接受度、可用性和覆盖范围。 下一步/实施：这项研究的结果将由一名由高铁和研发人员发起的调查人员进行补充 研究(IIR)建议在第三年检查退伍军人在GC/CT中使用非退伍军人护理的情况，并向 IIR建议在第5年进行有效性-实施试验，以在多个退伍军人管理局测试决策支持工具 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.