OEF/OIF Veterans with PTSD in Mental Health Residential Treatment Programs

OEF/OIF 患有 PTSD 的退伍军人参加心理健康住院治疗计划

• 批准号: 8396560
• 负责人: ERIC SLADE
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-10-01 至 2015-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8396560
• 关键词: Accident and Emergency department; Acute; Address; Admission activity; Area; Beds; Caring; Characteristics; Clinical; Comparative Study; Cost Savings; Costs and Benefits; Data; Databases; Decision Support Systems; Diagnosis; Economics; Expenditure; Fees; Freedom; General Practitioners; Group Therapy; Health Policy; Healthcare; Hour; ICD-9; Individual; Inpatients; Intensive Care; Interest Group; Interview; Length of Stay; Location; Measures; Mediating; Medical; Mental Health; Methods; Nurse Psychotherapist; Nurses; Observational Study; Outcome Study; Outpatients; Patients; Pharmaceutical Preparations; Physician Assistants; Post-Traumatic Stress Disorders; Primary Health Care; Probability; Process; Professional counselor; Program Evaluation; Provider; Psyche structure; Psychiatric Nursing; Psychiatrist; Psychiatry; Psychologist; Recommendation; Rehabilitation therapy; Research; Residential Treatment; Resource Allocation; Role; Sampling; Sampling Studies; Selection Bias; Services; Social Workers; Specific qualifier value; Structure; Substance abuse problem; System; Time; Treatment Cost; Veterans; base; comparative; comparison group; cost; demographics; health care cost/financing; informant; inpatient service; insight; meetings; operation; payment; programs; service utilization; treatment program

DESCRIPTION (provided by applicant): Background. Information about the costs, savings, and services utilization impacts of Department of Veterans Affairs (VA) mental health residential rehabilitation treatment services for Veterans of Operations Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) who have a post-traumatic stress disorder (PTSD) is critically needed. Residential treatment would be expected to result in greater receipt of psychotropic medications and outpatient services over sustained period of time as compared to other inpatient or outpatient PTSD care. As a result, residential treatment's greater costs may be offset by lower costs for other services. Aims. This retrospective observational study of OEF/OIF veterans admitted to PTSD residential, specialized PTSD outpatient, or PTSD inpatient treatment with a primary PTSD diagnosis (ICD-9 309.81) in fiscal years 2009 and 2010 (FY09 and FY10) has the following specific aims: 1) to assess the impacts of admission to PTSD-residential treatment on utilization of outpatient services, psychotropic medications, and acute care services, hours of provider contact, healthcare expenditures and VERA spending; 2) to examine whether the services utilization or expenditures impacts of residential treatment are mediated by a program's average length-of-stay or by patients' characteristics. For outpatient services, we examine mental health individual and group therapy and primary care. For acute care, we examine VA inpatient and emergency department use. For hours of provider contact, we examine contacts with psychiatrists, psychologists/social workers, general practitioners, substance abuse counselors, mental health nurses, and other nurses/physician assistants. Methods. An estimated 2671 unique OEF/OIF veterans with PTSD diagnoses were admitted to a PTSD- specialized residential treatment program in FY09 and FY10. Using propensity score matching and instrumental variables methods, we compare these patients' services utilization and costs-during two consecutive 6-month periods starting with their date of admission-to the study outcomes of two similar groups of OEF/OIF veterans. The first comparison group is OEF/OIF patients admitted to specialized outpatient PTSD services in FY09 or FY10. The second comparison group is OEF/OIF patients admitted with PTSD diagnoses to general psychiatric inpatient units. The study samples and clinical information are drawn from the National Center for PTSD database at the Northeast Program Evaluation Center (NEPEC). Data on services utilization, diagnoses, demographics, and VA service connection are drawn from the Medical SAS outpatient encounter and inpatient discharge files. Information on use of psychotropic medications and VA treatment costs will be drawn from Decision Support System (DSS) databases. Using propensity score matching, the comparison groups are selected to be similar to the group of interest (PTSD-residential patients) in terms of covariate means and standard deviations. Although propensity score matching can be used to adjust for group differences in measured covariates, it may not eliminate group differences in unmeasured confounders. To further minimize selection bias due to unmeasured confounders, instrumental variables estimation is used to estimate impacts of admission to residential treatment. Anticipated Impacts on Veteran's Healthcare. This is the first comparative economic and services utilization study of VA mental health residential treatment in more than a decade and the first ever of OEF/OIF veterans with PTSD. Synthesis of the empirical results and qualitative findings from key informant interviews may identify areas of unmet need in VA PTSD service delivery for OEF/OIF veterans and recommendations for enhancements of PTSD services through changes in VA healthcare policies, financing allocation, and/or program organization.

描述(由申请人提供)： 背景资料。迫切需要关于退伍军人事务部(VA)为患有创伤后应激障碍(PTSD)的持久自由作战(OEF)和伊拉克自由行动(OIF)退伍军人提供心理健康住宅康复治疗服务的成本、节省和服务利用影响的信息。与其他住院或门诊创伤后应激障碍治疗相比，住院治疗有望在持续的一段时间内更多地接受精神药物和门诊服务。因此，居民治疗的较高成本可能会被其他服务的较低成本所抵消。目标。这项针对2009年和309.81财年(2009财年和2010财年)住院治疗创伤后应激障碍的退伍军人、创伤后应激障碍专科门诊患者或初诊为创伤后应激障碍(ICD-9)的PTSD住院患者的回顾性观察研究有以下具体目的：1)评估进入创伤后应激障碍住院治疗对门诊服务、精神药物和急性护理服务的利用、提供者接触时间、医疗保健支出和VERA支出的影响；2)检查住院治疗的服务利用或支出是由计划的平均住院时间还是患者的特征调节的。对于门诊服务，我们检查心理健康，个人和团体治疗以及初级保健。对于急性护理，我们检查退伍军人管理局住院和急诊科的使用情况。在提供者联系的几个小时内，我们检查与精神病学家、心理学家/社会工作者、全科医生、药物滥用顾问、精神健康护士和其他护士/医生助理的联系。方法：研究方法。估计有2671名患有创伤后应激障碍的独特的OEF/OIF退伍军人在09财年和2010财年接受了创伤后应激障碍专门的住院治疗计划。使用倾向评分匹配和工具变量方法，我们将这些患者从入院日期开始的连续两个6个月期间的服务利用和成本与两组相似的OEF/OIF退伍军人的研究结果进行比较。第一个对照组是09财年或2010财年因创伤后应激障碍专科门诊入院的OEF/OIF患者。第二组为普通精神科住院的OEF/OIF患者，诊断为创伤后应激障碍。研究样本和临床信息来自东北项目评估中心(NEPEC)的国家创伤后应激障碍中心数据库。有关服务利用、诊断、人口统计和退伍军人管理局服务连接的数据来自医疗SAS门诊和住院患者出院档案。有关精神药物使用和VA治疗费用的信息将从决策支持系统(DSS)数据库中提取。使用倾向分数匹配，在协变量均值和标准差方面，选择与感兴趣的组(创伤后应激障碍住院患者)相似的对照组。虽然倾向评分匹配可以用来调整已测量协变量中的组差异，但它可能无法消除未测量混杂因素中的组差异。为了进一步减少由于未测量的混杂因素造成的选择偏差，使用工具变量估计来估计住院治疗的影响。对退伍军人医疗保健的预期影响。这是十多年来退伍军人精神卫生住院治疗的第一项比较经济和服务利用研究，也是第一次患有创伤后应激障碍的退伍军人。综合主要信息者访谈的经验结果和定性结果，可以确定退伍军人创伤后应激障碍服务交付中未得到满足的领域，并通过改变退伍军人医疗保健政策、融资分配和/或计划组织来加强创伤后应激障碍服务的建议。