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

描述（由申请人提供）： 背景关于成本，储蓄和服务利用退伍军人事务部（VA）心理健康住宅康复治疗服务的退伍军人持久自由行动（OEF）和伊拉克自由行动（OIF）谁有创伤后应激障碍（PTSD）的影响的信息是迫切需要的。与其他住院或门诊创伤后应激障碍护理相比，住院治疗预计将导致在持续的一段时间内接受更多的精神药物和门诊服务。因此，住院治疗的较高费用可能被其他服务的较低费用所抵消。目标。这项回顾性观察性研究的对象是OEF/OIF退伍军人，他们接受了创伤后应激障碍住院治疗、创伤后应激障碍专科门诊治疗或创伤后应激障碍住院治疗，（ICD-9 309.81），2009和2010财政年度（2009财年和2010财年）的具体目标如下：1）评估入院接受PTSD住院治疗对门诊服务、精神药物和急性护理服务利用的影响，提供者接触时间，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计划的平均住院时间或患者的特征介导。对于门诊服务，我们检查心理健康个人和团体治疗和初级保健。对于急性护理，我们检查VA住院和急诊科的使用。对于提供者接触的时间，我们检查与精神科医生，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/医生助理的接触。方法.在2009财年和2010财年，估计有2671名诊断为创伤后应激障碍的OEF/OIF退伍军人接受了创伤后应激障碍专门住院治疗计划。使用倾向评分匹配和工具变量方法，我们比较了这些患者的服务利用率和成本，在两个连续6个月的时间内，从他们的入院日期开始，两个类似的OEF/OIF退伍军人组的研究结果。第一个对照组是在FY 09或FY 10接受专门门诊PTSD服务的OEF/OIF患者。第二个对照组是OEF/OIF患者，他们被诊断为PTSD而被送入普通精神科住院部。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。关于服务利用、诊断、人口统计学和VA服务连接的数据来自Medical SAS门诊就诊和住院患者出院文件。关于精神药物使用和VA治疗费用的信息将来自决策支持系统（DSS）数据库。使用倾向评分匹配，选择在协变量平均值和标准差方面与目标组（PTSD住院患者）相似的比较组。虽然倾向评分匹配可用于调整测量协变量的组间差异，但可能无法消除未测量混杂因素的组间差异。为了进一步减少由于未测量的混杂因素造成的选择偏倚，使用工具变量估计来估计住院治疗的影响。预计对退伍军人的医疗保健的影响。这是十多年来第一次对VA心理健康住院治疗进行比较经济和服务利用研究，也是第一次对患有PTSD的OEF/OIF退伍军人进行研究。综合的实证结果和定性调查结果，从关键的线人访谈可以确定在VA创伤后应激障碍服务提供OEF/OIF退伍军人和建议，通过改变VA医疗保健政策，融资分配，和/或程序组织的创伤后应激障碍服务的未满足的需求领域。

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.