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: 9076127
• 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/9076127
• 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。关于持久自由的经营退伍军人（OEF）和伊拉克自由行动（OIF），资深人士事务部（VA）的成本，储蓄和服务利用的影响，他们具有关键的创伤后应激障碍（PTSD）。与其他住院或门诊PTSD护理相比，预计住院治疗将在持续时间内获得更多的精神药物和门诊服务。结果，其他服务的成本较低可能会抵消住宅待遇的更高成本。目标。这项回顾性的OEF/OIF退伍军人对PTSD住宅，专业PTSD门诊或PTSD住院治疗（ICD-9 309.81）（2009年和2010年）（FY09和FY10）（FY09和FY10）对PTSD诊断（ICD-9 309.81）进行的研究（FY09和FY10）对PTS的影响：1 ADM的影响。利用门诊服务，精神药物和急性护理服务，提供者联系时间，医疗支出和Vera支出； 2）检查服务利用或支出的影响是否是由计划的平均住宿时间或患者特征介导的。对于门诊服务，我们检查了心理健康个人和小组疗法和初级保健。为了进行急诊护理，我们检查了VA住院和急诊科的使用。在几个小时的提供者联系中，我们检查了与精神科医生，心理学家/社会工作者，全科医生，药物滥用辅导员，心理健康护士以及其他护士/医师助理的联系。方法。估计有2671名具有PTSD诊断的独特的OEF/OIF退伍军人在09财年和FY10中接受了PTSD专用住宅治疗计划。使用倾向评分匹配和仪器变量方法，我们比较了这些患者的服务利用率和成本，从他们的入院日期开始，与两个类似的OEF/OIF退伍军人组的研究成果开始。第一个比较组是OEF/OIF患者，该患者在09财年或FY10中接受专门的门诊PTSD服务。第二个比较组是接受PTSD诊断为普通精神病患者单位的OEF/OIF患者。研究样本和临床信息来自东北计划评估中心（NEPEC）国家PTSD数据库中心。服务利用率，诊断，人口统计和VA服务连接的数据来自医疗SAS门诊遭遇和住院排出文件。关于精神药物使用和VA治疗费用的使用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，根据协变量和标准偏差，选择了比较组与感兴趣的组（PTSD住宅患者）相似。尽管倾向得分匹配可用于调整测得的协变量的群体差异，但它可能无法消除未衡量的混杂因素的群体差异。为了进一步最大程度地减少由于无法衡量的混杂因素而导致的选择偏见，使用仪器变量估计来估计入院对住宅治疗的影响。对退伍军人的医疗保健的预期影响。这是十多年来VA心理健康住院治疗的第一项比较经济和服务利用研究，也是有史以来第一位具有PTSD的OEF/OIF退伍军人。来自主要线人访谈的经验结果和定性发现的综合可能会确定VA PTSD服务在OEF/OIF退伍军人的服务中未满足需求的领域，以及通过变更VA医疗保健政策，融资分配和/或计划组织来增强PTSD服务的建议。