Identifying Modifiable Factors that Affect Veterans At-Risk due to Social Determinants of Health and Psychological Distress Access to Care Within Integrated Primary Care Settings

确定影响因健康和心理困扰的社会决定因素而面临风险的退伍军人的可改变因素 在综合初级保健机构中获得护理的机会

• 批准号: 10452919
• 负责人: Jennifer S Funderburk
• 金额: --
• 依托单位: SYRACUSE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10452919
• 关键词: Address; Administrator; Affect; Area; Attention; Behavior; Care given by nurses; Caring; Case Manager; Characteristics; Clinical Nursing; Competence; Complex; Computerized Medical Record; Data; Data Sources; Dimensions; Equation; Evidence based intervention; Food; Future; Health; Health Services Accessibility; Healthcare; Homelessness; Housing; Improve Access; Intervention; Interview; Literature; Measures; Mediating; Mediator of activation protein; Medical; Mental Health; Mental Health Services; Methodology; Methods; Modeling; Monitor; Nurses; Patient Care; Patient-Focused Outcomes; Patients; Perception; Play; Population; Primary Health Care; Process; Provider; Publications; Quality of Care; Recommendation; Reporting; Research; Resources; Risk; Role; Sampling; Social Work; Social Workers; Structure; Surveys; Testing; Time; Training; Variant; Veterans; Visit; Work; burnout; care providers; care seeking; care systems; comorbidity; design; electronic data; evidence base; experience; food insecurity; housing instability; improved; innovation; meetings; member; military veteran; multidisciplinary; multiple data sources; novel; primary care setting; psychologic; psychological distress; psychosocial; skills; social; social health determinants; success

Background: Veterans are more likely to report psychological distress, which also elevates their risk for certain social determinants of health, such as unmet social needs (e.g., housing instability). As the entry point for most Veterans into care, the presence of multidisciplinary members on integrated Patient Aligned Care Teams (PACTs) in primary care, such as social workers and Primary Care Mental Health Integration (PCMHI) providers helps to address the wholistic needs of these Veterans by providing increased access to additional resources that have found to improve patient outcomes. Significance: However, prior research has showed that these integrated PACTs continue to demonstrate significant variation in meeting the needs of Veterans with psychological distress and unmet social needs (even with the skillsets brought to the PACT by the new members) leaving opportunities to improve access. Due to the negative impact of the comorbid experience of psychological distress and unmet social needs on Veteran’s health on health, identifying ways to optimize access to care within these integrated PACTs is an opportunity to reach a broad array of Veterans. Innovation and Impact: The proposed research is innovative through its attention to an underdeveloped area of the healthcare structure, integrated PACT characteristics, and its relationship with access. Informed by prior PACT implementation literature and a conceptual framework on patient navigation, integrated PACT characteristics include: structural, provider-specific, and team behaviors. Our aims seek to use mixed methods to provide a comprehensive understanding from multiple perspectives on PACT characteristics predictive of improved access and identify associated processes to achieve access within integrated PACTs within this high need population. These results will provide immediate guidance to VHA on the types of evidence-based interventions that can be utilized and practice changes that may support those interventions in achieving access to care for Veterans with unmet social needs and psychological distress. Specific Aims: Aim 1 will identify integrated PACT characteristics (provider, structural, and team behaviors) that significantly predict initial engagement to care among Veterans with unmet social needs and psychological distress. Hypothesis: Integrated PACT structural, such as staffing, and team behaviors, such as team meetings will be the strongest predictors of initial Veteran engagement in care. Aim 2 will identify best practices and perspectives from members and administrators within high performing integrated PACTs on ways to achieve optimization of significant integrated PACT characteristics supporting high levels of engagement among these Veterans. Aim 3 will test a model of hypothesized relationships between integrated PACT characteris tics and access as measured by Veterans’ perceptions of care (perceived access), ratings of quality of care, and engagement in care. Methodology: Aim 1 will combine data from two data sources (administrative data mixed with integrated PACT (n=160) surveys) to identify which integrated PACT characteristics significantly predict initial engagement, which will be defined as receipt of mental health or social resource care. Eligible Veterans have recently been seen in primary care, report current psychological distress and the presence of at least one unmet social need will be eligible. Aim 2 will use qualitative interviews to provide more in-depth information to identify best practices and perspectives from high-performing integrated PACT members and administrators (n=30). Aim 3 will use Aim 1 data and Veteran surveys (n=2000) to examine the role that Veterans’ perceptions of care and quality of care play within the relationship between integrated PACT characteristics and engagement in care using structural equation modeling. Steps/Implementation: Results will be shared via traditional publications, but also directly with key stakeholders in primary care, who will utilize these results to guide quality improvement projects. For instance, the results could help inform the PCMHI Competency training efforts on various PACT characteristics when training new PCMHI providers.

背景：退伍军人更有可能报告心理困扰，这也提高了他们的风险 某些健康的社会决定者，例如未满足的社会需求（例如住房不稳定）。作为入口点 对于大多数退伍军人，在综合患者对齐护理中的多学科成员的存在 初级保健的团队（协定），例如社会工作者和初级保健心理健康整合（PCMHI） 提供者通过提供更多的访问权限来帮助满足这些退伍军人的全面需求 发现改善患者预后的资源。意义：但是，先前的研究表明 这些综合公约继续显示出满足退伍军人需求的显着差异 有了心理困扰和未满足的社会需求（即使有了新的技能，新的技能 成员）留出改善访问权限的机会。由于合并经历的负面影响 心理困扰和对退伍军人健康健康的未满足的社会需求，确定了优化的方法 在这些综合协定中获得护理是一个机会，可以接触各种退伍军人。创新 和影响：拟议的研究是通过关注欠发达地区的创新性 医疗保健结构，综合协议特征及其与访问的关系。由以前的协议告知 实施文献和有关患者导航，综合协议特征的概念框架 包括：结构，提供者特定的和团队的行为。我们的目标试图使用混合方法来提供 从多个角度了解的全面理解，可预测改进的PACT特征 访问并确定相关的流程，以实现综合公约内的访问权限 人口。这些结果将为VHA提供有关基于证据的类型的立即指导 可以利用的干预措施并实践可能支持这些干预措施实现的更改 获得未满足的社会需求和心理困扰的退伍军人的护理。具体目的：目标1将 确定综合的协议特征（提供者，结构和团队行为） 预测具有未满足社会需求和心理学的退伍军人的初步关怀 困扰。假设：综合协议结构，例如人员配备和团队行为，例如团队会议 将是最初的老将参与护理的有力预测指标。 AIM 2将确定最佳实践，并且 高表现综合协定的成员和管理员的观点就实现方式 优化重要的综合协议特征，支持这些方面的高水平参与 退伍军人。 AIM 3将测试综合契约特征与 通过退伍军人对护理的看法（感知到访问），护理质量的评级和 参与护理。方法论：AIM 1将结合两个数据源的数据（管理数据混合） 与综合协议（n = 160）调查）以确定哪些综合协议特征可显着预测 最初的参与度将定义为获得心理健康或社会资源护理的接收。合格的退伍军人 最近在初级保健中看到了当前的心理困扰，至少有一个 未满足的社会需求将符合条件。 AIM 2将使用定性访谈提供更多深入的信息 从高性能的综合协议成员和管理员那里确定最佳实践和观点 （n = 30）。 AIM 3将使用AIM 1数据和退伍军人调查（N = 2000）来检查退伍军人的看法 在综合协议特征与 使用结构方程建模参与护理。步骤/实现：结果将通过 传统出版物，但也直接与基层医疗中的主要利益相关者一起使用，他们将利用这些结果来 指导质量改进项目。例如，结果可以帮助通知PCMHI的能力 培训新PCMHI提供商时，培训各种协议特征的培训。