Social and Behavioral Determinants of Health in High-Risk Veterans
高风险退伍军人健康的社会和行为决定因素
基本信息
- 批准号:10493192
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2021
- 资助国家:美国
- 起止时间:2021-10-01 至 2025-09-30
- 项目状态:未结题
- 来源:
- 关键词:AcademyAccident and Emergency departmentAddressAffectAreaBed OccupancyBehavioralBusinessesCOVID-19COVID-19 pandemicCaregiversCaringClinicalCommunitiesCommunity HealthcareCommunity ServicesCoupledDataDisadvantagedDisparityDisparity populationEconomicsElectronic Health RecordEmergency department visitEnvironmental Risk FactorEvaluationFinancial HardshipFundingFutureGoalsHealthHealth Care CostsHealth systemHealthcareHospital DepartmentsHospitalizationHospitalsIndividualIntegrated Health Care SystemsInterventionInterviewLeadLeadershipLifeLightLinkMeasurementMeasuresMedicareMedicineMethodologyMinorityModelingOutcomePatientsPopulationPositioning AttributePredictive ValuePrevalencePreventionPrimary CareProceduresProcessRecommendationReportingResearchResearch PersonnelRespondentRestRiskRisk AdjustmentRuralRural HealthSamplingScreening procedureShapesSocial isolationSurveysSystemTransportationTrustUnited States Department of Veterans AffairsVariantVeteransVeterans Health AdministrationWomanWomen&aposs HealthWorkcandidate identificationclinical carecosteconomic outcomeethnic minorityexperiencefood insecurityhealth care service utilizationhealth care settingshealth determinantshealth disparityhealth equityhealth recordhigh riskhousing instabilityimplementation barriersimplementation facilitatorsimprovedinnovationinteroperabilityoperationoutcome predictionpatient populationpoint of careracial minorityscreeningsocialsocial factorssocial health determinantssocial vulnerability
项目摘要
Background. Social factors exert a substantially more potent impact on health than does health care, especially
among disadvantaged populations such as VA users. Adverse social determinants of health (SDH)—factors such
as housing instability, food insecurity, social isolation, and transportation barriers—are linked to problems with
access, poorer clinical outcomes, and increased health care costs. Despite the clinical and business case for
integrating SDHs into health care, these factors are not systematically assessed or addressed in clinical settings.
Significance/Impact. This study will leverage a previous survey of Veterans at high-risk for hospitalization, and a
new survey to be fielded to a nationally-representative sample of Veterans, to determine how SDHs influence
clinical, health care utilization, and experience outcomes. Review of findings by key stakeholders will generate
recommended SDH measures for universal screening within VA. These steps, coupled with qualitative interviews
about implementation challenges, will inform the future integration of high-value patient-reported SDH measures
into VA’s health record.
Innovation. The proposed work is innovative in its evaluation of a broad array of SDHs in high-need Veterans
to identify candidate measures for electronic health record (EHR) integration. The study will leverage a
theoretically-driven survey of SDH measures with a data-driven approach to identifying the associations between
these SDHs and a range of health, utilization, and patient experience outcomes. Results from these analyses
will inform a facilitated deliberative process to prioritize high-value, validated, and actionable measures that are
predictive of outcomes that are important to Veterans and the VA.
Specific Aims. In Aim 1, we will use data from an Office of Primary Care-funded survey of Veterans at high-risk
for hospitalization to examine relationships between patient-reported SDH measures and utilization, cost, and days
in the community outcomes. In Aim 2, we will field a survey to a nationally-representative sample of VA patients to
determine the association between SDH measures and key outcomes, and to examine the prevalence of SDHs in
subpopulations of Veterans who are disproportionately affected by disparities (e.g., women, racial/ethnic minorities,
and rural Veterans). Aims 1 and 2 will inform partner and stakeholder discussions in Aim 3 to identify measures
that are associated with key outcomes and that are perceived by operations partners as actionable (i.e.,
addressable through VA or community services) and thereby good candidates for EHR integration.
Methodology. In Aim 1, we will leverage data from an operations-funded survey that our team administered in
2018. Using survey data for 4,685 Veterans at high-risk for hospitalization, we will examine the association
between patient-reported SDHs and utilization (i.e., VA and Medicare emergency department visits and
hospitalizations), VA and Medicare costs, and days in the community. In Aim 2, we will field a similar survey to
a nationally-representative sample of Veterans, evaluate the association between SDHs, patient experiences
(e.g., perceived access and coordination), and 12-month VA emergency department visits, hospitalizations, and
costs, and describe the prevalence of SDHs in the general VA population and Veterans who are at risk for health
disparities. In Aim 3, we will use a facilitated deliberative process with key stakeholders to prioritize actionable
SDH measures for EHR integration, and then conduct qualitative interviews with health system leaders,
clinicians, staff, and patients to examine implementation barriers and facilitators to assessing select SDH
measures at point of care.
Implementation/Next Steps. This study addresses health equity, particularly relevant in light of COVID-19, and
will be conducted with partners from VA’s Offices of Primary Care, Health Equity, Rural Health, and Women’s
Health. The study is especially timely with VA’s transition to the new Cerner EHR as the proposed aims will identify
SDH measures for potential EHR integration that are concise, actionable, and predictive of important outcomes.
背景社会因素对健康的影响比医疗保健要大得多,
在弱势群体中,如VA用户。健康的不利社会决定因素-诸如
由于住房不稳定、粮食不安全、社会孤立和交通障碍,
获得,较差的临床结果和增加的医疗保健费用。尽管临床和商业案例
将SDH纳入医疗保健,这些因素没有在临床环境中进行系统评估或解决。
意义/影响。这项研究将利用先前对住院高风险退伍军人的调查,
一项新的调查将被派往一个具有全国代表性的退伍军人样本,以确定SDHS如何影响
临床、卫生保健利用和经验结果。主要利益攸关方对调查结果的审查将产生
建议在VA内进行普遍筛查的SDH措施。这些步骤加上定性访谈
关于实施挑战,将为未来整合高价值患者报告的SDH措施提供信息
退伍军人管理局的健康记录
创新拟议的工作是创新的,在其评估的一系列广泛的SDHs在高需求的退伍军人
确定电子健康记录(EHR)集成的候选措施。该研究将利用
以数据驱动的方法对SDH措施进行理论驱动的调查,以确定
这些SDH和一系列健康、利用和患者体验结果。这些分析的结果
将告知一个便利的审议过程,以优先考虑高价值,有效和可操作的措施,
对退伍军人和退伍军人事务部很重要的结果的预测。
具体目标。在目标1中,我们将使用初级保健办公室资助的高风险退伍军人调查数据
住院检查患者报告的SDH措施和利用,成本和天之间的关系
在社区的成果。在目标2中,我们将对具有全国代表性的VA患者样本进行调查,
确定SDH指标与关键结局之间的关联,并检查
受差异影响不成比例的退伍军人亚群(例如,妇女、少数种族/族裔、
农村退伍军人)。目标1和2将为目标3中的伙伴和利益攸关方讨论提供信息,以确定措施
与关键结果相关联并且被运营伙伴认为是可操作的(即,
可通过VA或社区服务寻址),从而是EHR集成的良好候选者。
方法论在目标1中,我们将利用我们的团队在年进行的一项运营资助调查的数据,
2018.使用4,685名住院高风险退伍军人的调查数据,我们将研究该协会
在患者报告的SDH和利用率之间(即,VA和Medicare急诊科就诊,
住院),VA和医疗保险费用,以及在社区的天数。在目标2中,我们将进行类似的调查,
具有全国代表性的退伍军人样本,评估SDS、患者经历
(e.g.,感知的访问和协调),以及12个月的VA急诊科就诊,住院,
成本,并描述在一般VA人群和有健康风险的退伍军人中SDH的患病率
差距。在目标3中,我们将与关键利益相关者一起使用便利的审议流程,
SDH措施的EHR整合,然后进行定性访谈卫生系统的领导人,
临床医生、工作人员和患者检查评估选择SDH的实施障碍和促进因素
在护理点采取措施。
执行/后续步骤。这项研究涉及健康公平,特别是在COVID-19的背景下,
将与弗吉尼亚州初级保健、健康公平、农村健康和妇女事务办公室的合作伙伴一起进行。
健康这项研究是特别及时的VA的过渡到新的Cerner EHR作为拟议的目标将确定
SDH衡量潜在的EHR集成,简洁,可操作,并预测重要的结果。
项目成果
期刊论文数量(0)
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MATTHEW L MACIEJEWSKI其他文献
MATTHEW L MACIEJEWSKI的其他文献
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{{ truncateString('MATTHEW L MACIEJEWSKI', 18)}}的其他基金
Social and Behavioral Determinants of Health in High-Risk Veterans
高风险退伍军人健康的社会和行为决定因素
- 批准号:
10313362 - 财政年份:2021
- 资助金额:
-- - 项目类别:
Measuring the Longitudinal Relationshipsbetween Obesity, Weight Management Intervention, and Medical Expenditure
测量肥胖、体重管理干预和医疗支出之间的纵向关系
- 批准号:
10209965 - 财政年份:2019
- 资助金额:
-- - 项目类别:
Measuring the Longitudinal Relationshipsbetween Obesity, Weight Management Intervention, and Medical Expenditure
测量肥胖、体重管理干预和医疗支出之间的纵向关系
- 批准号:
10759361 - 财政年份:2019
- 资助金额:
-- - 项目类别:
Risk Stratification and Tailoring of Prevention Programs
风险分层和预防计划的定制
- 批准号:
9768329 - 财政年份:2016
- 资助金额:
-- - 项目类别:
Long-term Mental Health Outcomes of Bariatric Surgery
减肥手术的长期心理健康结果
- 批准号:
9352800 - 财政年份:2016
- 资助金额:
-- - 项目类别:
Long-term Mental Health Outcomes of Bariatric Surgery
减肥手术的长期心理健康结果
- 批准号:
9922248 - 财政年份:2016
- 资助金额:
-- - 项目类别:
Long-term Mental Health Outcomes of Bariatric Surgery
减肥手术的长期心理健康结果
- 批准号:
9076320 - 财政年份:2016
- 资助金额:
-- - 项目类别: