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

描述（由申请人提供）： 背景。迫切需要有关退伍军人事务部 (VA) 心理健康住院康复治疗服务对患有创伤后应激障碍 (PTSD) 的持久自由行动 (OEF) 和伊拉克自由行动 (OIF) 退伍军人的成本、节省和服务利用影响的信息。与其他住院或门诊 PTSD 护理相比，预计住院治疗将在持续一段时间内获得更多的精神药物和门诊服务。因此，住院治疗的较高成本可能会被其他服务较低的成本所抵消。目标。这项对 2009 财年和 2010 财年（2009 财年和 2010 财年）接受 PTSD 住院治疗、专业 PTSD 门诊治疗或 PTSD 住院治疗（ICD-9 309.81）的 PTSD 住院治疗的 OEF/OIF 退伍军人进行的回顾性观察研究有以下具体目的： 1) 评估入院 PTSD 住院治疗对门诊服务、精神药物和急性治疗的使用的影响护理服务、提供者联系时间、医疗保健支出和 VERA 支出； 2) 检查住院治疗的服务利用或支出影响是否由项目的平均住院时间或患者特征介导。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。对于急症护理，我们检查了 VA 住院和急诊科的使用情况。对于提供者的接触时间，我们会检查与精神科医生、心理学家/社会工作者、全科医生、药物滥用顾问、心理健康护士和其他护士/医师助理的接触情况。方法。 2009 财年和 2010 财年，估计有 2671 名患有 PTSD 诊断的独特 OEF/OIF 退伍军人接受了 PTSD 专门住院治疗计划。使用倾向评分匹配和工具变量方法，我们将这些患者的服务利用率和成本（从入院日期开始的两个连续 6 个月期间）与两组相似的 OEF/OIF 退伍军人的研究结果进行比较。第一个比较组是 2009 财年或 2010 财年接受专门门诊 PTSD 服务的 OEF/OIF 患者。第二个比较组是因 PTSD 诊断而入住普通精神科住院病房的 OEF/OIF 患者。研究样本和临床信息取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 VA 服务连接的数据取自 Medical SAS 门诊就诊和住院出院文件。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) 数据库中获取。使用倾向评分匹配，选择在协变量均值和标准差方面与感兴趣组（PTSD 住院患者）相似的比较组。尽管倾向得分匹配可用于调整测量协变量中的群体差异，但它可能无法消除未测量混杂因素中的群体差异。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。这是十多年来首次对 VA 心理健康住院治疗进行比较经济和服务利用研究，也是首次针对患有 PTSD 的 OEF/OIF 退伍军人进行研究。综合主要知情人访谈的实证结果和定性发现，可以确定 VA 为 OEF/OIF 退伍军人提供 PTSD 服务时未满足的需求领域，并提出通过改变 VA 医疗保健政策、融资分配和/或项目组织来加强 PTSD 服务的建议。

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.