Addressing Social Determinants of Health Among Rural Veterans

解决农村退伍军人健康的社会决定因素

• 批准号: 10677535
• 负责人: Deborah Gurewich
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10677535
• 关键词: Accounting; Address; COVID-19; Cardiovascular Diseases; Caring; Characteristics; Clinical; Collaborations; Communities; Data; Development; Disease; Economic Conditions; Economics; Effectiveness; Epidemiology; Evaluation; Feedback; Future; Goals; Health; Health Services Research; Healthcare; Homelessness; Human Resources; Individual; Inequity; Infrastructure; Intervention; Interview; Knowledge; Logistics; Medical center; Methodology; Methods; Mission; Modeling; New England; Outcome; Outcome Assessment; Patients; Phase; Policy Maker; Population; Positioning Attribute; Prevalence; Process; Provider; Randomized, Controlled Trials; Replicating Effective Programs; Research; Resources; Risk; Rural; Rural Community; Rural Health; Scientific Advances and Accomplishments; Service setting; Services; Site; Social Conditions; Social Network; Social Work; Specific qualifier value; Suicide; Surveys; System; Time; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; Work; care outcomes; comorbidity; economic need; effectiveness/implementation study; evidence base; experience; food insecurity; health equity; implementation barriers; improved; information gathering; innovation; intervention refinement; novel; pilot test; preference; research and development; routine screening; rural America; rural setting; screening; social; social adversity; social health determinants; urban area; urban setting; user centered design

Background: Rural Veterans represent over one third of all Veterans served by the Department of Veterans Affairs and rural America is strikingly different than urban areas with respect to the social and economic conditions that drive health. Based on research documenting the relationship between social adversity (e.g., homelessness, food insecurity) and health, policy makers suggest routine screening and referral (S&R) for unmet social and economic needs (hereafter: “unmet needs”) in the clinical setting. This call has catalyzed a small but promising evidence base, indicating that efficacy of S&R. However, the S&R evidence base focuses on unmet needs in urban settings. This means we lack the knowledge needed to adapt unmet need S&R for the unique needs of rural VA settings and the rural Veterans they serve. Significance: Our study addresses the HSR&D priorities to mitigate the unmet needs of Veterans and to integrate heath care solutions as much as possible into existing care, rather than depending on new personnel and resources. This study will advance these priorities by adapting the specifications of evidence-based S&R to align with existing unmet needs and unmet need resources in rural VA settings. This study will also establish a process for adapting S&R that can be replicated across VISNs and facilities. Innovation and Impact: This research is highly innovative as we know of no research that is implementing unmet need interventions for rural Veterans. We will provide novel knowledge about unmet needs among rural Veterans, the mechanism by which these needs manifest, and the social service infrastructure within the VA and community that serve rural Veterans. Our research is also innovative in our use of user-centered design (UCD) methods to adapt the specifications of an S&R intervention. Specifically, throughout the process of adapting S&R to the target local sites, we will engage and solicit feedback from the eventual end-users, including Veterans. Specific Aims: 1) Determine unmet needs among rural Veterans and their associations with health outcomes; 2) Assess existing systems for addressing unmet needs and adapt S&R to fit local conditions and stakeholder preferences; 3) Pilot test the adapted intervention and develop an Adaptation Playbook. Methodology: Guided by the Replicating Effective Programs (REP) framework, we propose a 3-year mixed- methods study. We will survey rural Veterans served by VISN 1 about their unmet needs and merge survey data with secondary VA data to assess the scope and scale of unmet needs and their associations with health care outcomes. We will conduct qualitative interviews with key stakeholders (Veterans, VA providers and staff, representatives of community agencies) to understand how unmet needs manifest among rural Veterans, the existing infrastructure for identifying unmet needs and referring for services, and opportunities and preferences for adapting S&R. We will use the information gathered from these interviews and UCD methods to adapt the specifications of S&R. Finally, we will pilot the adapted S&R intervention, refine as needed, and develop an Adaptation Playbook detailing how other facilities can adapt S&R to their local conditions. Next Steps/Implementation: Upon completion of the IIR, we will have moved through the first two of four REP phases (pre-conditions and pre-implementation). By doing so, we will understand the key components necessary for REP phases three and four, which will be the focus of future work (full-scale implementation of the adapted S&R intervention and evaluation) in on-going collaboration with our operational partners the New England Veterans Integrated Service Network, Office of Rural Health and Office of Social Work.

背景：农村退伍军人占退伍军人部服务的所有退伍军人的三分之一以上 美国的事务和农村地区在社会和经济方面与城市地区有着显着的不同 促进健康的条件。基于记录社会逆境之间关系的研究（例如， 无家可归、粮食不安全）和健康，政策制定者建议对以下人群进行常规筛查和转诊（S&R）： 临床环境中未满足的社会和经济需求（以下简称“未满足的需求”）。这一呼吁催生了 小但有希望的证据基础，表明 S&R 的功效。然而，S&R 证据基础侧重于 城市环境中未满足的需求。这意味着我们缺乏适应未满足的需求 S&R 所需的知识 农村退伍军人事务部及其服务的农村退伍军人的独特需求。 意义：我们的研究解决了 HSR&D 的优先事项，以缓解退伍军人未满足的需求并 尽可能将医疗保健解决方案整合到现有护理中，而不是依赖新人员 和资源。这项研究将通过调整循证 S&R 的规范来推进这些优先事项 与农村退伍军人事务部现有的未满足需求和未满足需求资源保持一致。这项研究还将建立 可以在 VISN 和设施之间复制的调整 S&R 的流程。 创新和影响：这项研究具有高度创新性，因为据我们所知还没有正在实施的研究 对农村退伍军人未满足的需求进行干预。我们将提供有关农村未满足需求的新知识 退伍军人、这些需求体现的机制以及退伍军人管理局内的社会服务基础设施 和为农村退伍军人服务的社区。我们的研究在使用以用户为中心的设计方面也是创新的 （UCD）方法来适应 S&R 干预的规范。具体来说，在整个过程中 使 S&R 适应目标本地站点，我们将参与并征求最终用户的反馈， 包括退伍军人。 具体目标： 1) 确定农村退伍军人中未满足的需求及其与健康结果的关系； 2) 评估现有系统以解决未满足的需求，并调整 S&R 以适应当地条件和利益相关者 偏好； 3) 对适应的干预措施进行试点测试并制定适应手册。 方法：在复制有效计划 (REP) 框架的指导下，我们提出了一个为期 3 年的混合计划 方法研究。我们将对 VISN 1 服务的农村退伍军人进行调查，了解他们未满足的需求并合并调查 数据与辅助 VA 数据一起评估未满足需求的范围和规模及其与健康的关系 护理结果。我们将与主要利益相关者（退伍军人、VA 提供者和工作人员、 社区机构的代表）了解农村退伍军人中未满足的需求是如何体现的 用于识别未满足需求并转介服务、机会和偏好的现有基础设施 用于调整 S&R。我们将使用从这些访谈和 UCD 方法中收集的信息来调整 S&R 规格。最后，我们将试点经过调整的 S&R 干预措施，根据需要进行完善，并开发一个 适应手册详细介绍了其他设施如何使 S&R 适应当地条件。 后续步骤/实施：完成 IIR 后，我们将完成四个 REP 中的前两个 阶段（先决条件和预实施）。通过这样做，我们将了解关键组件 REP第三阶段和第四阶段所必需的，这将是未来工作的重点（全面实施 与我们的运营合作伙伴持续合作的适应的 S&R 干预和评估） 英格兰退伍军人综合服务网络、农村卫生办公室和社会工作办公室。