Understanding Pathways to Care for Veterans who Screen Positive for PTSD: The PTSD Access To Healthcare (PATH) Study

了解护理 PTSD 筛查呈阳性的退伍军人的途径：PTSD 获得医疗保健 (PATH) 研究

• 批准号: 10493181
• 负责人: Michelle Bovin
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10493181
• 关键词: Area; Caring; Classification; Clinic; Clinical; Community Healthcare; Consult; Data; Data Analyses; Enrollment; Ensure; Evidence based intervention; Evidence based treatment; Funding; Goals; Guidelines; Health Services Accessibility; Healthcare; Homogeneously Staining Region; Impairment; Improve Access; Individual; Intake; Intervention; Interview; Lead; Leadership; Link; Maps; Media Campaign; Medical; Mental Health; Mental Health Services; Mental disorders; Methodology; Methods; Military Personnel; Pathway interactions; Patients; Pilot Projects; Policies; Post-Traumatic Stress Disorders; Predictive Factor; Primary Care; Process; Provider; Quality of life; Research Design; Role; Running; Schedule; Series; Site; Structure; Suicide; Symptoms; System; Testing; Veterans; Work; adverse outcome; data warehouse; development policy; experience; falls; follow-up; health care availability; implementation strategy; improved; individual variation; innovation; insight; medical specialties; predictive modeling; primary care clinic; response; screening; suicidal

Background: Nearly half of Veterans who screen positive for PTSD in VA primary care clinics do not receive VA mental health treatment. To increase timely access to VA care, we must understand Veterans’ access pathways (the series of options offered to, and choices made by, Veterans after a positive PTSD screen that may lead them to VA care). Mapping these pathways is key to understanding who is being lost to VA care and where they are being lost. Further, by examining contextual and individual factors that predict who and where Veterans are falling off these pathways, we will be able to ascertain why these Veterans are being lost. Significance: The proposed IIR is responsive to the HSR&D priorities of both mental health and access to care and will provide insight into the impact of the MISSION Act on mental health access. At the completion of this project, we will provide three distinct deliverables: 1) guidance on where and to whom access interventions should be targeted; 2) policy and practice guidance to aid providers in linking Veterans who screen positive to effective VA care; and 3) a method for classifying Veterans from screening to VA mental health care, which could be extended to other conditions (e.g. suicidality). Innovation and Impact: Past research designed to provide information to improve access to PTSD care has been limited by focusing on the end goal (whether these Veterans do or do not access care) rather than the process by which Veterans arrive at this goal (the access pathways). The proposed project is not only one of the first to consider access to care as a process rather than an end point, it is the only study to propose examining the process of access comprehensively using a method that will generalize to the VA system as a whole, and will be applicable to other healthcare conditions identified by VA-based screening. Specific Aims: The proposed mixed methods study has the following aims: 1. Aim 1: Identify contextual- and individual-level variables that differentiate Veterans classified into a VA initial access step (an immediate response to a positive PTSD screen in primary care likely to lead to VA care; e.g., referral to PC-MHI) from those who were not, including those referred to community care via the MISSION Act. 2. Aim 2: Understand VA providers’ and patients’ experiences with, and perspectives on, why Veterans are lost to VA follow-up care immediately after screening positive for PTSD, including the role of the MISSION Act. 3. Aim 3: Map the access pathway steps hypothesized to follow each of the six initial VA access steps, as well as the step hypothesized to lead to community care provided via the MISSION Act, by leveraging the methods developed in our pilot work. Methodology: Aim 1 will include all Veterans with new PTSD screens in primary care between FY 2017-2019. Data from the VA Corporate Data Warehouse (CDW) will be used to determine Veteran access step classification and to identify contextual and individual variables that significantly predict classification. Aim 2 will use the data from Aim 1 to identify high- and low-performing sites, and qualitative interviews will be conducted with site stakeholders to understand access barriers and facilitators. Aim 3 will use quantitative data extracted from the VA CDW to map the remaining steps in the access pathways to identify which Veterans are lost to follow-up, and where. Predictive models using relevant access variables identified in Aims 1 and 2 will be run. Next Steps/Implementation: Results from the proposed IIR will inform the best ways to deploy and tailor existing access interventions (e.g. PC-MHI, direct-to-Veteran media campaigns). We will work with the Office of Primary Care to develop policy and practice guidance, and work with both the Office of Primary Care and NCPTSD leadership to disseminate guidelines and our methodology to VA primary care and PC-MHI leadership at the national level. We will begin testing implementation strategies in a subsequent IIR.

背景：在退伍军人事务部初级保健诊所筛查PTSD呈阳性的退伍军人中，近一半没有收到 退伍军人协会精神健康治疗。为了增加及时获得退伍军人护理的机会，我们必须了解退伍军人的获得情况 路径(退伍军人在接受阳性创伤后应激障碍筛查后提供的一系列选项和他们做出的选择 可能会导致他们接受退伍军人管理局的护理)。绘制这些路径图是了解退伍军人管理局护理和 在那里他们迷路了。此外，通过检查预测谁和在哪里的背景和个人因素 退伍军人正在从这些道路上跌落，我们将能够确定这些退伍军人迷失的原因。 意义：拟议的IIR回应了HSR&D的精神健康和获得 并将深入了解《使命法》对心理健康服务的影响。在完成时 在这个项目中，我们将提供三个不同的交付成果：1)关于在哪里和向谁提供干预措施的指导 应有针对性；2)向援助提供者提供政策和实践指导，将筛查呈阳性的退伍军人与 有效的退伍军人保健；以及3)退伍军人从筛查到退伍军人精神卫生保健的分类方法，该方法 可以扩展到其他情况(例如自杀)。 创新和影响：过去的研究旨在提供信息，以改善获得创伤后应激障碍护理的机会 受到关注最终目标(无论这些退伍军人是否获得护理)的限制，而不是 退伍军人达到这一目标的过程(通道)。拟议中的项目不仅是 这是第一个将获得护理视为一个过程而不是终点的研究，它是唯一一项提出 使用一种将退伍军人制度概括为 整个，并将适用于基于退伍军人管理局的筛查确定的其他医疗保健条件。 具体目标：拟议的混合方法研究有以下目标： 1.目标1：确定区分退伍军人分类为退伍军人首字母的背景变量和个人变量 进入步骤(对初级保健中可能导致退伍军人管理局护理的阳性PTSD筛查的立即反应； 例如，转诊到PC-MHI)来自那些没有转诊的人，包括那些通过 《使命法案》。 2.目标2：了解退伍军人服务提供者和患者对退伍军人迷失原因的体验和看法 对创伤后应激障碍筛查阳性后立即给予退伍军人事务部后续护理，包括使命法案的作用。 3.目标3：也绘制假设遵循六个初始VA接入步骤中的每一个的接入途径步骤 作为通过《使命法案》提供社区护理的假设步骤，通过利用 在我们的试点工作中发展的方法。 方法：AIM 1将包括2017-2019年期间在初级保健中接受新PTSD筛查的所有退伍军人。 来自退伍军人事务部数据仓库(CDW)的数据将用于确定退伍军人访问步骤 分类，并找出显著预测分类的背景变量和个体变量。目标2将 使用AIM 1中的数据来识别高绩效和低绩效的网站，并进行定性访谈 与站点利益相关者一起了解访问障碍和促进者。目标3将使用提取的定量数据 从VA CDW映射访问路径中的剩余步骤，以确定哪些退伍军人失去了 后续行动，地点。将运行使用目标1和目标2中确定的相关准入变量的预测模型。 下一步/实施：拟议的IIR的结果将为部署和定制的最佳方式提供信息 现有的准入干预措施(例如，PC-MHI、直接面向资深媒体的活动)。我们将与该办公室合作 初级保健办公室，以制定政策和实践指导，并与初级保健办公室和 NCPTSD领导向退伍军人事务部初级保健和PC-MHI传播指南和我们的方法 国家层面的领导力。我们将在随后的IIR中开始测试实施策略。