Serving All Who Have Served: Enhancing Suicide-Related Care Quality for Black, Indigenous, and People of Color Veterans

背景：预防退伍军人自杀仍然是退伍军人健康管理局的首要临床任务 (VHA)。为了降低退伍军人自杀的风险，VHA有国家指南建议加强护理方案 在自我导向的暴力(SDV)之后，例如创建自杀安全计划或增加门诊频率 心理健康探视。坚持每个特定的护理成分被认为是自杀的护理质量的标志 风险(以下简称自杀相关护理质量)。利用国家VHA数据进行的最新研究 表明这些护理组成部分可能不会公平地提供给所有退伍军人。研究表明，布莱克， 土著和有色人种(BIPOC)退伍军人的心理健康护理质量比白人差 对于退伍军人来说，类似的问题可能会影响他们与自杀相关的护理质量。然而，没有研究表明 Date调查了BIPOC退伍军人中与自杀相关的护理质量。因此，进一步评价 需要与自杀相关的护理质量，以确保对患有SDV的BIPOC退伍军人进行公平、有效的护理。这个 目前的提案寻求评估BIPOC退伍军人中自杀相关护理质量的组成部分，使用 同时，混合方法三角方法，以通知未来的干预发展。 意义：拟议的项目直接涉及VHA的临床首要任务--预防自杀。在……里面 此外，这项建议也符合退伍军人事务部HSR&D高度优先关注的自杀预防和健康公平 作为VHA国家战略计划目标2.1和2.3的重点是确保退伍军人获得公平的待遇， 全面的自杀预防服务，以支持他们的康复。VHA健康公平和VHA办公室 心理健康和预防自杀办公室也在其战略计划中强调需要支持 为所有退伍军人提供与自杀相关的公平护理。 创新和影响：拟议的项目是BIPOC对自杀相关护理质量的首次评估 患有SDV的退伍军人。此外，到目前为止，还没有研究确定改善自杀相关护理质量的领域 为BIPOC退伍军人准备的。使用与BIPOC资深人士三角测量的国家VHA和非VHA管理数据 而心理健康临床医生的定性数据将使当前影响因素的概念化更加丰富 与自杀有关的护理，并为今后加强护理的战略提供信息。 具体目标：目标1)评估BIPOC退伍军人自杀相关护理质量；目标2)进行定性 采访BIPOC退伍军人和退伍军人临床医生以更好地了解影响自杀相关护理的因素 BIPOC退伍军人的质量；目标3)探索医疗保健系统水平因素与自杀之间的联系- BIPOC退伍军人相关护理质量指标；探索性目标)探索自杀与- 退伍军人的相关护理质量与自杀结局。 方法：AIM 1将利用VHA数据库识别患有SDV(FY18-FY22)的BIPOC退伍军人。数据来自 VHA公司数据仓库，用于与自杀相关的护理质量结果以及社会人口和 临床变量将联系在一起。数据将使用广义估计方程进行分析。目标2将涉及 采访了至少40名BIPOC退伍军人和至少40名VHA心理健康临床医生，了解他们的信念和 与自杀相关的护理经验，将使用专题分析进行分析。AIM 3将链接来自 目标1到站一级的卫生保健系统因素。因为探索性的目标是将数据与死亡率数据联系起来 来源，以探索与死亡结果的联系。 下一步/实施：建议的项目将增加我们对影响自杀的因素的了解- BIPOC退伍军人相关护理质量调查这个项目的发现将为未来的提案提供信息，重点是 提高退伍军人自杀相关护理质量的干预研究。

Background: Veteran suicide prevention remains the top clinical priority for the Veterans Health Administration (VHA). To mitigate Veteran suicide risk, VHA has national guidelines recommending an enhanced care package after self-directed violence (SDV) such as creating a suicide safety plan or increasing the frequency of outpatient mental health visits. Adherence to each given care component is considered a marker of care quality for suicide risk (henceforth referred to as suicide-related care quality). Recent research utilizing national VHA data suggests these care components may not be provided equitably to all Veterans. As research shows that Black, Indigenous, and People of Color (BIPOC) Veterans experience poorer mental health care quality than white Veterans, it is possible that similar issues may impact their suicide-related care quality. However, no research to date has examined the quality of suicide-related care among BIPOC Veterans. Thus, further evaluation of suicide-related care quality is needed to ensure equitable, effective care for BIPOC Veterans with SDV. The current proposal seeks to evaluate components of suicide-related care quality among BIPOC Veterans using a concurrent, mixed-methods triangulation approach to inform future intervention development. Significance: The proposed project directly addresses VHA’s top clinical priority, suicide prevention. In addition, this proposal aligns with VA HSR&D’s high priority foci of suicide prevention and health equity as well as VHA National Strategic Plan Objectives 2.1 and 2.3 which focus on ensuring Veterans receive equitable, comprehensive suicide prevention services to support their recovery. VHA Office of Health Equity and VHA Office of Mental Health and Suicide Prevention also highlight in their strategic plans the need for supporting equitable, suicide-related care for all Veterans. Innovation and Impact: The proposed project is the first evaluation of suicide-related care quality among BIPOC Veterans with SDV. In addition, no research to date has determined areas to improve suicide-related care quality for BIPOC Veterans. Use of national VHA- and non-VHA administrative data triangulated with BIPOC Veteran and mental health clinician qualitative data will result in a richer conceptualization of current factors impacting suicide-related care and inform future strategies for enhancing care. Specific Aims: Aim 1) Evaluate suicide-related care quality among BIPOC Veterans; Aim 2) Conduct qualitative interviews with BIPOC Veterans and VA clinicians to better understand factors impacting suicide-related care quality for BIPOC Veterans; Aim 3) Explore associations between health care systems-level factors and suicide- related care quality indicators for BIPOC Veterans; Exploratory Aim) Explore the relationship between suicide- related care quality among BIPOC Veterans and suicide outcomes. Methodology: Aim 1 will identify BIPOC Veterans with SDV (FY18-FY22) utilizing VHA databases. Data from the VHA Corporate Data Warehouse for suicide-related care quality outcomes as well as sociodemographic and clinical variables will be linked. Data will be analyzed using generalized estimating equations. Aim 2 will involve interviews with at least 40 BIPOC Veterans and at least 40 VHA mental health clinicians about their beliefs and experiences with suicide-related care which will be analyzed using thematic analysis. Aim 3 will link data from Aim 1 to health care systems factors at the station level. For the Exploratory Aim will link data from mortality data sources to explore associations with mortality outcomes. Next Steps/ Implementation: The proposed project will increase our understanding of factors impacting suicide- related care quality among BIPOC Veterans. Findings from this project will inform future proposals focused on intervention development to enhance suicide-related care quality among BIPOC Veterans.