Eating Disorder Screening and Diagnostic Tools for the Veteran Healthcare System

退伍军人医疗保健系统的饮食失调筛查和诊断工具

• 批准号: 10651595
• 负责人: Shira Maguen
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-12-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10651595
• 关键词: Address; Affect; Age; Anorexia Nervosa; Assessment tool; Binge Eating; Binge eating disorder; Bulimia; Caring; Caucasians; Cessation of life; Characteristics; Clinic; Clinical; Clinical Pathways; Complement; Computerized Medical Record; Connecticut; DSM-V; Data; Development; Diagnosis; Diagnostic; Diagnostic and Statistical Manual of Mental Disorders; Diet Habits; Disease; Eating Behavior; Eating Disorders; Ensure; Evaluation; Feedback; Female; Foundations; Future; Gender; General Population; Goals; Grant; Guidelines; Health; Health Services; Health Services and Mental Health Administration; Healthcare Systems; High Prevalence; Interview; Language; Life; Literature; Measures; Mental Health; Mental disorders; Methods; Military Personnel; Newly Diagnosed; Obesity; Overweight; Pathway interactions; Patient Self-Report; Patients; Population; Prevalence; Primary Care; Probability; Process; Property; Provider; Psychometrics; Publications; Publishing; Questionnaires; Recommendation; Research; Risk Factors; Sampling; San Francisco; Screening procedure; Series; Services; Specificity; Surveys; Symptoms; System; Time; Training; Training Programs; Translating; Underweight; Update; Veterans; Veterans Health Administration; Weight; Weight Gain; Weight maintenance regimen; Woman; Women' s Health Services; Work; care outcomes; care systems; clinical diagnostics; clinical practice; demographics; diagnostic criteria; diagnostic tool; evidence base; falls; girls; healthy weight; implementation tool; improved; improved outcome; instrument; male; medical specialties; meetings; men; military service; military veteran; mortality; multidisciplinary; older men; premature; programs; recruit; response; screening; screening guidelines; service gap; service member; standardized care; suicide rate; systematic review; tool

Eating disorders are serious psychiatric disorders that are associated with a range of significant health problems, including elevated mortality and suicide rates. A recent systematic review found prevalence rates of eating disorders among Veteran and Service Members to be comparable to or higher than prevalence estimates for the general population. Our pilot data, as well as published data by others, has demonstrated that 15-25% of Veterans meet diagnostic criteria for eating disorders when assessed, in contrast to Veteran electronic medical record data that reveals eating disorders are underdiagnosed. At the same time, the proportion of Veterans in the Veterans Health Administration (VHA) with eating disorders are increasing due to several factors, including the growing number of women in the military, expansions of eating disorder diagnostic criteria, and increasing numbers of Veterans affected by risk factors for eating disorders that are characteristic of military life. Although eating disorders are not thought of as service-related conditions that may also impact male Veterans, poor eating habits under stressful conditions while in the military can set the foundation for disordered eating behavior and trajectories of weight gain post-military in both female and male Veterans. Currently, there are no VHA recommended guidelines for eating disorder screening or diagnosis. Consequently, eating disorders in Veterans may be undetected, resulting in insufficient or delayed treatment, and in the worst case, premature death. Eating disorders identification and treatment has been identified as a top priority by facility-level stakeholders from mental health. In response, VHA Mental Health Services and Women’s Health Services are disseminating a clinician training program for the multidisciplinary care of eating disorders. While the ultimate goal is to implement this training nationwide, the health services challenge is how to best establish a clinical pathway that includes targeted screening and diagnosis to best identify Veterans who need this specialty care. Our goal is to develop an evidence-based clinical pathway to identify eating disorders in the Veteran population that will aid in standardizing care and improving outcomes for Veterans. We will use a mixed methods approach with three specific aims. The first aim will be to further develop and validate a primary care eating disorder screen for DSM-5 that is generalizable for Veterans. The second aim will be to validate a self-report measure of eating disorders that assesses for all DSM-5 diagnostic criteria and is generalizable for Veterans. The third aim will be to assess how to best implement the screen and measure across VHA for clinical practice. In our quantitative study (Aims 1 and 2), we will recruit Veterans from the San Francisco VA Healthcare System and VA Connecticut Healthcare System. Veterans (N=400) will complete a series of questionnaires to identify eating disorder symptoms. A random subset of those with and without probable eating disorders (n=156) will be invited to participate in a gold-standard diagnostic clinical interview to validate the proposed screen and self-report measure for the full spectrum of eating disorder diagnoses. In order to revalidate the screen, we will subsequently recruit Veterans from a national Veteran sample to complete the proposed screen and self-report diagnostic measure (N=400). Concurrently for our qualitative study (Aim 3), we will interview stakeholders (N=38; VHA patients, providers, and leaders) on how to best implement the screen and self-report diagnostic measure across multiple VHA-user entry points (Primary Care, Mental Health, Women’s Clinic, and the VA National Weight Management Program, MOVE!). Our aims will allow us to fill a gap through partnered work and stakeholder feedback, and help build a clinical pathway to identify Veterans that may be falling through the cracks and not getting the care that they need. This project meets several strategies consistent with the VHA Blueprint for Excellence including meeting the “unique needs” of Veterans, providing a clinical pathway for “high quality, Veteran-centered care,” and “leading the nation in research and treatment of military service-related conditions.”

进食障碍是严重的精神疾病，与一系列重要的健康问题有关。 问题，包括死亡率和自杀率上升。最近的一项系统回顾发现， 退伍军人和服务人员中的饮食失调与患病率相当或高于患病率 一般人口的估计数。我们的试验数据以及其他人公布的数据表明， 15-25%的退伍军人在接受评估时符合饮食失调的诊断标准，而退伍军人 电子病历数据显示饮食失调是诊断不足。同时对 退伍军人健康管理局（VHA）中患有饮食失调的退伍军人比例正在增加， 几个因素，包括越来越多的妇女在军队，扩大饮食失调， 诊断标准，越来越多的退伍军人受到饮食失调风险因素的影响， 军事生活的特点。虽然饮食失调不被认为是与服务有关的条件， 也影响男性退伍军人，不良的饮食习惯，在紧张的条件下，而在军队可以设置 男女军人饮食行为紊乱和体重增加轨迹的基础 老兵目前，没有VHA推荐的饮食失调筛查或诊断指南。 因此，退伍军人的饮食失调可能未被发现，导致治疗不足或延迟， 最坏的情况是过早死亡饮食失调的识别和治疗已被确定为一个 设施一级的利益攸关方将精神卫生列为最优先事项。作为回应，VHA心理健康服务和 妇女健康服务部正在推广一项临床医生培训计划，对饮食进行多学科护理。 紊乱虽然最终目标是在全国范围内实施这一培训，但卫生服务面临的挑战是如何实施 最好地建立一个临床路径，包括有针对性的筛查和诊断，以最好地识别退伍军人 需要这种特殊护理的人我们的目标是开发一种循证临床路径， 这将有助于标准化护理和改善退伍军人的结果。 我们将采用混合方法，有三个具体目标。第一个目标是进一步发展和 验证DSM-5的初级保健饮食失调筛查，该筛查适用于退伍军人。第二个目的 将验证一个自我报告的饮食失调的措施，评估所有DSM-5诊断标准， 对退伍军人来说是普遍的。第三个目标是评估如何最好地实施筛选和衡量 用于临床实践。在我们的定量研究（目标1和2）中，我们将招募来自San Francisco的退伍军人， 弗朗西斯科VA医疗保健系统和VA康涅狄格州医疗保健系统。退伍军人（N=400）将完成 一系列的问卷调查，以确定饮食失调的症状。一个随机的子集， 可能的饮食失调（n=156）将被邀请参加金标准诊断临床访谈， 验证所提出的筛查和自我报告措施，以全面诊断进食障碍。在 为了重新验证筛选，我们随后将从全国退伍军人样本中招募退伍军人， 完成拟定筛查和自报诊断措施（N=400）。同时，对于我们的定性 研究（目标3），我们将采访利益相关者（N=38; VHA患者，提供者和领导者），了解如何最好地 在多个VHA用户入口点（初级保健， 心理健康，妇女诊所，和VA国家体重管理计划，移动！）。我们的目标将 使我们能够通过合作工作和利益相关者的反馈来填补空白，并帮助建立临床路径， 找出退伍军人，可能会通过裂缝下降，并没有得到他们需要的照顾。这个项目 满足与VHA卓越蓝图一致的几个战略，包括满足“独特的 需要”的退伍军人，提供了一个临床路径“高质量，退伍军人为中心的护理，”和“领导 国家在研究和治疗与兵役有关的条件”。