Quality of Mental Health Services for Homeless Veterans in Primary Care Settings

初级保健机构中无家可归退伍军人的心理健康服务质量

• 批准号: 10390340
• 负责人: AUDREY L JONES
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10390340
• 关键词: Adopted; Caring; Clinical; Communities; Community Services; Data; Disease; Effectiveness; Elements; Emergency department visit; Enrollment; Environment; Fellowship; Foundations; Future; Goals; Health; Health Services; Health Services Accessibility; Homelessness; Hospitalization; Intervention; Interview; Investments; Laboratories; Lead; Leadership; Location; Major Depressive Disorder; Measures; Mental Depression; Mental Health; Mental Health Services; Mentors; Mentorship; Methodology; Methods; Modeling; Organizational Change; Outcome; Overdose; Patients; Performance; Population; Postdoctoral Fellow; Preparation; Primary Health Care; Process Measure; Provider; Publishing; Qualitative Methods; Quality of Care; Recording of previous events; Recovery; Reporting; Research; Research Personnel; Research Priority; Risk; Science; Services; Site; Social Work; Specialist; Structure; Substance abuse problem; Suicide; Surveys; Testing; Time; Training; United States Department of Veterans Affairs; Variant; Veterans; Veterans Health Administration; Visit; Work; addiction; base; care delivery; community setting; comparative; design; effectiveness evaluation; effectiveness implementation study; evidence base; experience; high risk; implementation design; implementation efforts; implementation framework; implementation research; implementation science; implementation study; improved; improved outcome; innovation; military veteran; opioid overdose; opioid use disorder; primary care services; primary care setting; programs; service coordination; skills; substance abuse treatment; therapy design

Background: My long-term goal is to become an independent VA health services researcher focused on designing and testing integrated care solutions to improve mental health and substance abuse (MHSA) services access, quality, and outcomes for vulnerable Veteran populations. This CDA-2 will provide me with the necessary mentorship, skills, and experiences to evaluate, modify and implement organizational changes that improve MHSA outcomes for vulnerable Veterans in primary care settings. Significance/Impact: Veterans who have been homeless have high rates of depression and opioid use disorder and barriers to accessing traditional primary care services. It is important to determine effective models of MHSA services integration at this time when Veterans have more options for care in VA and community settings. VA’s homeless patient aligned care team (H-PACT) program, implemented in over 60 VA facilities, offers a natural laboratory to determine optimal approaches of MHSA services integration to advance Veteran health. My research will impact Veteran health by determining the effectiveness of H-PACT for providing high quality MHSA care and mitigating adverse MHSA outcomes among homeless-experienced Veterans; and by determining the unique and potentially modifiable aspects of H-PACT and other patient aligned care teams (PACTs) that could be scaled to achieve superior MHSA outcomes for homeless-experienced Veterans in specialized and non-specialized PACT settings. This research strongly aligns with VA research priorities of mental health and primary care, and legislative priorities related to addiction recovery and community care. Innovation: While prior studies suggest H-PACT improves primary care utilization and Veteran experiences with care, there is less research focused on determining what features of H-PACT are successful. We lack data on clinical process measures and outcomes for Veterans empaneled in H-PACTs, information on aspects of MHSA services integration that exists within H-PACTs and traditional PACTs caring for homeless-experienced Veterans, and the barriers and facilitators that contribute to MHSA quality for homeless-experienced Veterans. Specific Aims: My CDA-2 has three primary aims: 1) Compare MHSA services quality of care (e.g., clinical performance measures for depression, opioid use disorder) and outcomes (e.g., psychiatric hospitalization, opioid-related overdose, suicide) for homeless-experienced Veterans empaneled in H-PACTs versus other PACTs in the same facilities; 2) Measure levels and features of MHSA services integration (e.g., coordination with community services, co-location of providers, full integration) for homeless-experienced Veterans in H- PACTs and other PACTs; and 3) Evaluate MHSA service practices and barriers in 4 facilities ranked low and 4 ranked high on measures of MHSA services quality for homeless-experienced Veterans. I will work with my mentors to develop the expertise to study MHSA services quality in primary care settings, and to augment my foundational training with new skills in survey design, qualitative methods and implementation science. Methodology: I aim to 1) use VA administrative data to operationalize MHSA services quality of care based on VA performance measures and established definitions; 2) adapt an organizational survey of H-PACT structures to survey providers from H-PACTs and PACTs about how MHSA services integration is achieved for homeless-experienced Veterans, and; 3) conduct stakeholder interviews in low and high performing facilities to identify barriers to delivering high quality MHSA services for homeless-experienced Veterans. Next Steps/Implementation: Findings will provide information to VA providers, operational partners, and leadership about the effectiveness of the H-PACT initiative, and targets for intervention to bolster lower performing H-PACTs. My pre-implementation research findings and training experiences will inform my future work focused on MHSA outcomes in specialized PACT settings, including an HSR&D effectiveness- implementation study (IIR) application to improve MHSA services quality for homeless Veterans in PACTs.

背景：我的长期目标是成为专注于的独立VA卫生服务研究人员 设计和测试综合护理解决方案以改善心理健康和药物滥用（MHSA）服务 弱势退伍军人人口的访问，质量和结果。这个CDA-2将为我提供 评估，修改和实施组织变革的必要精神，技能和经验 改善初级保健环境中脆弱退伍军人的MHSA成果。 意义/影响力：无家可归的退伍军人的抑郁率很高和使用 进入传统初级保健服务的障碍和障碍。确定有效模型很重要 当时，退伍军人在VA和社区中有更多护理选择的MHSA服务集成 设置。 VA的无家可归者对齐护理团队（H-PACT）计划，在60多个VA设施中实施， 提供自然实验室，以确定MHSA服务集成的最佳方法以促进退伍军人 健康。我的研究将通过确定H条纹提供高度的有效性来影响退伍军人健康 无家可归的退伍军人之间的优质MHSA护理和减轻不良MHSA的结果；和 确定H-PACT和其他患者对齐护理团队的独特且可能修改的方面 （条约）可以缩放以实现无家可归经验的退伍军人的优质MHSA结果 专业和非专业协议设置。这项研究与VA研究的重点保持一致 心理健康和初级保健，以及与成瘾恢复和社区护理有关的立法优先事项。 创新：虽然先前的研究表明H-PACT可改善初级保健利用和退伍军人体验 通过谨慎，较少的研究重点是确定H-PACT的哪些特征成功。我们缺乏数据 关于临床过程的措施和结果，以H条形为empanele的退伍军人，有关 MHSA服务集成在H条形和传统协议内，可用于无家可归的经验 退伍军人，以及为无家可归者经验的退伍军人提供MHSA质量的障碍和促进者。 具体目的：我的CDA-2具有三个主要目的：1）比较MHSA服务护理质量（例如临床 抑郁症，阿片类药物使用障碍的绩效指标）和结果（例如，精神病医院， 阿片类药物相关的过量，自杀），用于无家可归的退伍军人，以H条纹与其他人相比 同一设施中的协定； 2）MHSA服务集成的度量水平和特征（例如协调 通过社区服务，提供者的共同设置，完全集成），用于无家可归的退伍军人 协定和其他条约； 3）评估4个排名低的4个设施中的MHSA服务实践和障碍 评分为无家可归者经验的退伍军人的MHSA服务质量措施。我会和我的 指导者开发专业知识来研究MHSA服务质量在初级保健环境中，并增加我的 具有新技能的基础培训，在调查设计，定性方法和实施科学方面。 方法：我的目标是1）使用VA管理数据来操作MHSA服务基于护理质量 关于VA绩效措施和既定定义； 2）调整H-PACT的组织调查 来自H条形和有关MHSA服务集成的协议的调查提供者的结构 无家可归的退伍军人； 3）在低表现设施中进行利益相关者的访谈 确定为无家可归的退伍军人提供高质量MHSA服务的障碍。 下一步/实施：调查结果将向VA提供者，运营合作伙伴和 领导H-PACT倡议的有效性，以及用于加强降低的干预目标 执行H条形。我的实施前研究结果和培训经验将为我的未来提供信息 专注于专门协议设置中的MHSA结果的工作，包括HSR＆D有效性 - 实施研究（IIR）应用程序，以提高公约中无家可归的退伍军人的MHSA服务质量。