Veteran Interactions with VA Primary Care Prior to Suicide

退伍军人在自杀前与退伍军人管理局初级保健机构的互动

• 批准号: 8374093
• 负责人: Steven K Dobscha
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8374093
• 关键词: Acute; Address; Age; Anxiety; Caring; Case-Control Studies; Cessation of life; Characteristics; Clinical; Clinical Nurse Specialists; Clinical assessments; Data; Decision Support Systems; Disease; Exhibits; Feeling suicidal; Firearms; Freedom; Frequencies; General Population; Goals; Health Care Visit; Health Personnel; Health Priorities; Healthcare; Individual; Information Systems; Inpatients; Link; Matched Group; Medical; Medical Records; Mental Depression; Mental Health; Methods; Military Personnel; Modeling; Operative Surgical Procedures; Pain; Patients; Pharmaceutical Preparations; Positioning Attribute; Post-Traumatic Stress Disorders; Precipitating Factors; Predisposing Factor; Prevalence; Prevention strategy; Primary Health Care; Process; Provider; Psychiatric Diagnosis; Psychosocial Assessment and Care; Recording of previous events; Reporting; Research; Risk Factors; Sampling; Shapes; Site; Subgroup; Substance Use Disorder; Suicide; Suicide prevention; Symptoms; System; Traumatic Brain Injury; Veterans; Violence; Visit; accomplished suicide; emotional distress; experience; follow-up; health care service utilization; high risk; improved; information gathering; male; operation; primary care setting; sex; stressor; suicidal risk; suicide rate

Anticipated Impacts on Veterans' Healthcare: Study results have the potential to 1) identify gaps and barriers within the primary care setting in the identification and treatment of veterans at high risk for suicide completion, 2) identify specific characteristics of patients seen in VA primary care that are associated with high risk of suicide completion, 3) identify patient, provider and system characteristics that are associated with receipt of care related to suicide prevention, and 4) shape healthcare and suicide prevention efforts to the unique needs of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans. Project Background: Prior research suggests that veterans are twice as likely to die by suicide compared to non-veteran civilians, and each year, as many as 6,500 veterans take their own lives. Many patients visit healthcare clinicians prior to suicide. Primary care clinicians may be in a unique position to intervene with these patients. Unfortunately, little is known about the characteristics of patients who make contact with primary care clinicians prior to suicide, as well as the content of these patient-clinician interactions. It is thus unclear what opportunities may exist within primary care for intervening with individuals at highest risk for suicide. Project Objectives: The goal of this project is to inform VA suicide prevention strategies by describing and evaluating the VA primary care received by veteran suicide decedents in the year prior to death. Specifically, we will 1) describe characteristics of, and healthcare received by suicide decedents in VA primary care settings in the year prior to death, and compare this healthcare to healthcare received by a matched sample of veterans who did not complete suicide; 2) evaluate content of last interactions of veteran suicide decedents with VA primary care teams; and 3) describe characteristics of, and VA primary care received by OEF/OIF veteran suicide decedents and compare these characteristics and care to those of other veteran patient groups. Project Methods: This is a retrospective descriptive and case-control study. We will link National Violent Death Reporting System Data (NVDRS) from 10 States with the VA Decision Support System (DSS) to identify veterans who completed suicide from 2005 to 2009 and who received VA healthcare in the 12 months prior to death. NVDRS data include demographic information (including patient identifiers), means of death, and other variables. DSS will provide additional demographic, clinical (general medical and psychiatric diagnoses), and healthcare utilization (types and numbers of visits, medications) data. The OEF/OIF Roster will be used to identify OEF/OIF status and will provide military history information for the subgroup of OEF/OIF veterans. We will conduct medical record review using VA VistAWeb to access individual medical records (including progress notes) from all VA sites within participating states, and gather information on the content of healthcare visits. Medical record review variables include whether clinicians screened or assessed for depression, substance use disorder, post-traumatic stress disorder, suicidal ideation, predisposing and protective factors for suicide, reasons for last contacts, and presence of emotional distress at last contacts. Analyses will be stratified by sex. We will summarize demographic and clinical characteristics, variables describing primary care team assessments, and clinical actions taken for veterans who completed suicide. We will compare characteristics of, and healthcare received by, suicide decedents to those of a 1:1 control sample of age, sex, and primary care provider-matched veterans who did not complete suicide. Robust estimates of the standard errors will be used to adjust for clustering within states. Regression models will be adjusted for covariates identified in preliminary analyses. We will also compare characteristics of and healthcare received by OEF/OIF veterans to 1:2 matched control samples of 1) other veterans who completed suicide, and 2) OEF/OIF veterans who did not complete suicide.

对退伍军人医疗保健的预期影响：研究结果有可能 1) 确定初级保健机构在识别和治疗自杀完成高风险退伍军人方面的差距和障碍，2) 确定退伍军人管理局初级保健机构中与自杀高风险相关的患者的具体特征 自杀完成，3) 确定与接受自杀预防相关护理相关的患者、提供者和系统特征，以及 4) 根据持久自由行动/伊拉克自由行动 (OEF/OIF) 退伍军人的独特需求制定医疗保健和自杀预防工作。 项目背景：之前的研究表明，退伍军人自杀身亡的可能性是非退伍军人平民的两倍，每年有多达 6,500 名退伍军人自杀。许多患者在自杀前去看医生。初级保健临床医生可能处于对这些患者进行干预的独特地位。不幸的是，人们对自杀前与初级保健临床医生接触的患者的特征以及这些患者与临床医生互动的内容知之甚少。因此，尚不清楚初级保健中可能存在哪些机会对自杀风险最高的个人进行干预。 项目目标：该项目的目标是通过描述和评估退伍军人自杀死者在死亡前一年接受的退伍军人管理局初级护理，为退伍军人管理局自杀预防策略提供信息。具体来说，我们将 1) 描述 VA 初级保健机构中自杀死者的特征和接受的医疗保健 死亡前一年，并将这种医疗保健与未完成自杀的退伍军人的匹配样本所接受的医疗保健进行比较； 2) 评估退伍军人自杀死者与 VA 初级保健团队最后互动的内容； 3) 描述 OEF/OIF 退伍军人自杀死者的特征和 VA 初级护理，并将这些特征和护理与其他退伍军人患者的特征和护理进行比较 组。 项目方法：这是一项回顾性描述性病例对照研究。我们将把来自 10 个州的国家暴力死亡报告系统数据 (NVDRS) 与退伍军人管理局决策支持系统 (DSS) 联系起来，以确定 2005 年至 2009 年完成自杀以及在死亡前 12 个月内接受退伍军人管理局医疗保健的退伍军人。 NVDRS 数据包括人口统计信息（包括患者标识符）、死亡方式和其他信息 变量。 DSS 将提供额外的人口统计、临床（一般医学和精神病诊断）和医疗保健利用（就诊类型和次数、药物）数据。 OEF/OIF 名册将用于确定 OEF/OIF 状态，并为 OEF/OIF 退伍军人小组提供军事历史信息。我们 将使用 VA VistAWeb 进行医疗记录审查，以访问参与州内所有 VA 站点的个人医疗记录（包括进度说明），并收集有关医疗保健就诊内容的信息。病历审查变量包括临床医生是否筛查或评估抑郁症、物质使用障碍、创伤后应激障碍、自杀意念、易感性和 自杀的保护因素、最后一次接触的原因以及最后一次接触时是否存在情绪困扰。 分析将按性别分层。我们将总结人口统计和临床特征、描述初级保健团队评估的变量以及为完成自杀的退伍军人采取的临床行动。我们将自杀死者的特征和接受的医疗保健与 1:1 对照样本进行比较 年龄、性别和初级保健提供者匹配的未完成自杀的退伍军人。标准误差的稳健估计将用于调整州内的聚类。回归模型将针对初步分析中确定的协变量进行调整。我们还将比较其特征和所接受的医疗保健 由 OEF/OIF 退伍军人与 1:2 匹配的对照样本组成：1) 其他完成自杀的退伍军人，以及 2) 未完成自杀的 OEF/OIF 退伍军人。