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一名独立的VA健康服务研究人员， 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 弱势退伍军人群体的准入、质量和成果。这个CDA-2将为我提供 必要的指导，技能和经验，以评估，修改和实施组织变革， 改善MHSA结果为脆弱的退伍军人在初级保健设置。 意义/影响：无家可归的退伍军人抑郁症和阿片类药物使用率很高 获得传统初级保健服务的障碍。确定有效的模型很重要 在退伍军人有更多选择在VA和社区护理的时候，MHSA服务整合 设置. VA的无家可归的病人对齐护理团队（H-PACT）计划，在60多个VA设施实施， 提供了一个天然的实验室，以确定MHSA服务整合的最佳方法，以促进退伍军人 健康我的研究将通过确定H-PACT为退伍军人提供高质量医疗服务的有效性来影响退伍军人健康。 优质的MHSA护理和减轻无家可归的退伍军人中不良的MHSA结果;以及 确定H-PACT和其他与患者相关的护理团队的独特性和潜在可修改性 （PACTs），可以扩展，以实现无家可归的退伍军人的上级MHSA结果， 专业和非专业PACT设置。这项研究与VA的研究重点非常一致， 精神健康和初级保健，以及与戒毒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改善了初级保健利用率和退伍军人的经验 但是，关注于确定H-PACT的哪些功能是成功的研究较少。我们缺乏数据 关于H-PACTs中的退伍军人的临床过程措施和结果， MHSA服务整合存在于H-PACTs和传统PACTs内，照顾无家可归的人 退伍军人，以及有助于无家可归的退伍军人的MHSA质量的障碍和促进者。 具体目标：我的CDA-2有三个主要目标：1）比较MHSA服务的护理质量（例如，临床 抑郁症、阿片类药物使用障碍的表现测量）和结果（例如，精神科住院治疗， 阿片类药物相关的过量，自杀）为无家可归的经验丰富的退伍军人与其他 2）测量MHSA服务集成的水平和特征（例如，协调 与社区服务，供应商的共同定位，充分整合）为无家可归的经验丰富的退伍军人在H- PACTs和其他PACTs;以及3）评估MHSA服务实践和4个设施中的障碍， 在为无家可归的退伍军人提供MHSA服务质量的措施上排名靠前。我将与我的 导师发展专业知识，研究MHSA服务质量在初级保健设置，并增加我的 基础培训，掌握调查设计、定性方法和实施科学方面的新技能。 方法：我的目标是1）使用VA管理数据来操作MHSA服务， 2）调整对人力资源管理统一行动方案的组织调查 调查H-PACTs和PACTs的提供商如何实现MHSA服务集成， 无家可归的退伍军人，以及; 3）在低绩效和高绩效设施中进行利益相关者访谈， 确定障碍，提供高质量的MHSA服务无家可归的退伍军人的经验。 后续步骤/实施：调查结果将为VA提供商、运营合作伙伴和 关于H-PACT倡议的有效性的领导，以及干预目标，以支持较低的 进行H-PACTs我的实施前研究结果和培训经验将为我的未来提供信息 工作重点是在专业PACT环境中的MHSA结果，包括HSR & D有效性- 实施研究（IIR）的应用，以提高MHSA的服务质量为无家可归的退伍军人在PACTs。