Identifying Modifiable Factors that Affect Veterans At-Risk due to Social Determinants of Health and Psychological Distress Access to Care Within Integrated Primary Care Settings

确定影响因健康和心理困扰的社会决定因素而面临风险的退伍军人的可改变因素 在综合初级保健机构中获得护理的机会

• 批准号: 10658878
• 负责人: Jennifer S Funderburk
• 金额: --
• 依托单位: SYRACUSE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10658878
• 关键词: Address; Administrator; Affect; Area; Attention; Behavior; Care given by nurses; Caring; Case Manager; Characteristics; Clinical Nursing; Competence; Complex; Computerized Medical Record; Data; Data Sources; Dimensions; Eligibility Determination; Equation; Evidence based intervention; Food; Future; Health; Health Services Accessibility; Healthcare; Homelessness; Housing; Improve Access; Intervention; Interview; Literature; Measures; Mediating; Mediator; Medical; Mental Health; Mental Health Services; Methodology; Methods; Modeling; Monitor; Nurses; Patient-Focused Outcomes; Patients; Perception; Play; Population; Primary Care; Process; Provider; Publications; Quality of Care; Quality of life; Recommendation; Reporting; Research; Resources; Risk; Role; Sampling; Social Work; Social Workers; Structure; Surveys; Testing; Time; Training; Variant; Veterans; Visit; Work; burnout; care seeking; care systems; comorbidity; design; electronic data; experience; food insecurity; housing instability; improved; innovation; meetings; member; military veteran; multidisciplinary; multiple data sources; novel; patient navigation; primary care patient; primary care provider; primary care setting; psychologic; psychological distress; psychosocial; skills; social; social health determinants; success

Background: Veterans are more likely to report psychological distress, which also elevates their risk for certain social determinants of health, such as unmet social needs (e.g., housing instability). As the entry point for most Veterans into care, the presence of multidisciplinary members on integrated Patient Aligned Care Teams (PACTs) in primary care, such as social workers and Primary Care Mental Health Integration (PCMHI) providers helps to address the wholistic needs of these Veterans by providing increased access to additional resources that have found to improve patient outcomes. Significance: However, prior research has showed that these integrated PACTs continue to demonstrate significant variation in meeting the needs of Veterans with psychological distress and unmet social needs (even with the skillsets brought to the PACT by the new members) leaving opportunities to improve access. Due to the negative impact of the comorbid experience of psychological distress and unmet social needs on Veteran’s health on health, identifying ways to optimize access to care within these integrated PACTs is an opportunity to reach a broad array of Veterans. Innovation and Impact: The proposed research is innovative through its attention to an underdeveloped area of the healthcare structure, integrated PACT characteristics, and its relationship with access. Informed by prior PACT implementation literature and a conceptual framework on patient navigation, integrated PACT characteristics include: structural, provider-specific, and team behaviors. Our aims seek to use mixed methods to provide a comprehensive understanding from multiple perspectives on PACT characteristics predictive of improved access and identify associated processes to achieve access within integrated PACTs within this high need population. These results will provide immediate guidance to VHA on the types of evidence-based interventions that can be utilized and practice changes that may support those interventions in achieving access to care for Veterans with unmet social needs and psychological distress. Specific Aims: Aim 1 will identify integrated PACT characteristics (provider, structural, and team behaviors) that significantly predict initial engagement to care among Veterans with unmet social needs and psychological distress. Hypothesis: Integrated PACT structural, such as staffing, and team behaviors, such as team meetings will be the strongest predictors of initial Veteran engagement in care. Aim 2 will identify best practices and perspectives from members and administrators within high performing integrated PACTs on ways to achieve optimization of significant integrated PACT characteristics supporting high levels of engagement among these Veterans. Aim 3 will test a model of hypothesized relationships between integrated PACT characteris tics and access as measured by Veterans’ perceptions of care (perceived access), ratings of quality of care, and engagement in care. Methodology: Aim 1 will combine data from two data sources (administrative data mixed with integrated PACT (n=160) surveys) to identify which integrated PACT characteristics significantly predict initial engagement, which will be defined as receipt of mental health or social resource care. Eligible Veterans have recently been seen in primary care, report current psychological distress and the presence of at least one unmet social need will be eligible. Aim 2 will use qualitative interviews to provide more in-depth information to identify best practices and perspectives from high-performing integrated PACT members and administrators (n=30). Aim 3 will use Aim 1 data and Veteran surveys (n=2000) to examine the role that Veterans’ perceptions of care and quality of care play within the relationship between integrated PACT characteristics and engagement in care using structural equation modeling. Steps/Implementation: Results will be shared via traditional publications, but also directly with key stakeholders in primary care, who will utilize these results to guide quality improvement projects. For instance, the results could help inform the PCMHI Competency training efforts on various PACT characteristics when training new PCMHI providers.

背景：退伍军人更有可能报告心理困扰，这也增加了他们患上 健康的某些社会决定因素，例如未得到满足的社会需求(例如住房不稳定)。作为入口点 对于大多数进入护理的退伍军人来说，多学科成员的存在是对患者进行整合的护理 初级保健团队(公约)，如社会工作者和初级保健精神卫生一体化(PCMHI) 提供商通过增加对其他服务的访问，帮助满足这些退伍军人的整体需求 已经发现可以改善患者预后的资源。重要意义：然而，先前的研究表明 这些综合公约在满足退伍军人的需求方面继续表现出显著的差异 心理痛苦和未得到满足的社会需求(即使新的协议带来了技能 成员)为改善访问留下机会。由于共病经历的负面影响， 心理困扰和未满足的社会需求对退伍军人健康的影响，确定优化途径 在这些综合条约中获得护理是接触到广泛的退伍军人的机会。创新 和影响：拟议的研究是创新的，因为它关注了 医疗保健结构、综合公约特征及其与可获得性的关系。由先前的协议通知 实施文献和关于患者导航、综合PACT特征的概念框架 包括：结构化行为、特定于提供者的行为和团队行为。我们的目标是寻求使用混合方法来提供 从多个角度全面理解PACT预测改进的特征 访问并确定相关流程，以在此高需求的综合协议中实现访问 人口。这些结果将为VHA提供关于循证类型的即时指导 可利用的干预措施，并实行可支持这些干预措施实现 有未得到满足的社会需求和心理困扰的退伍军人得到照顾的机会。具体目标：目标1将 确定集成的契约特征(提供商、结构和团队行为) 预测未满足社会需求和心理需求的退伍军人的初始参与度 苦恼。假设：整合的契约结构，如人员配备，以及团队行为，如团队会议 将是退伍军人最初参与护理的最强有力的预测因素。目标2将确定最佳实践和 高绩效综合协议中的成员和管理员对实现以下目标的方法的看法 优化重要的综合契约特征，支持其中的高水平接触 退伍军人。目标3将测试一个假设的模型，该模型描述了综合契约特征和 可获得性由退伍军人对护理的感知(感知可获得性)、护理质量评级和 全身心投入到护理中。方法：AIM 1将合并来自两个数据源的数据(混合管理数据 使用综合PACT(n=160)调查)，以确定哪些综合PACT特征可显著预测 初始参与，这将被定义为接受心理健康或社会资源护理。符合条件的退伍军人 最近在初级保健中心看到过，报告说目前有心理困扰，至少有一个 未满足的社会需求将符合条件。目标2将使用定性访谈提供更深入的信息，以 从高绩效的综合协议成员和管理员那里确定最佳做法和观点 (n=30)。目标3将使用目标1数据和退伍军人调查(n=2000)来检查退伍军人的认知 护理和护理质量在综合公约特征和护理质量之间的关系中发挥作用 使用结构方程模型进行护理投入。步骤/实施：结果将通过以下方式共享 传统出版物，也直接与初级保健领域的关键利益攸关方合作，他们将利用这些成果 指导质量提升工程。例如，结果可能有助于告知PCMHI能力 在培训新的PCMHI提供者时，就各种PACT特征进行培训。