Access to and Choice of VA or Non-VA Health Care by Veterans of Recent Conflicts

背景：这个CDA将为我，Megan E.Vanneman，博士，公共卫生硕士，提供培训和 成为一名独立的卫生服务研究员的经验，应用决策科学和 信息学，以改善退伍军人获得和参与高质量护理的机会。为了帮助实现这一目标，我 我将与我的导师、顾问和运营合作伙伴一起开发和评估信息和 提高退伍军人管理局领导对退伍军人管理局招生和决策的理解和决策的决策支持工具 依赖(退伍军人管理局接受的护理的比例)初级和精神卫生保健。 意义/影响：这项研究将对退伍军人管理局领导人、退伍军人产生积极影响 参加退伍军人保健，以及需要初级和精神卫生保健的退伍军人，通过增加 了解如何优化访问、质量、注册和依赖，以更好地满足退伍军人的 需要。随着退伍军人管理局从更加封闭、集成的医疗系统转向通过网络提供医疗服务 包括社区合作伙伴，退伍军人管理局领导人需要更好地了解注册、依赖、访问和 当地设施和VISN的质量，特别是初级和精神科等“基础服务”的质量 医疗保健。CDA与退伍军人管理局的首要任务紧密一致--增加退伍军人的选择，使 VA系统，更高效地利用VA资源，提高服务的及时性。 创新：虽然我们知道大约50%的退伍军人参加退伍军人管理局，而大约50%的退伍军人关心这些 参与者是退伍军人管理局提供的，我们对最近做出这些决定的原因知之甚少 分散服役人员--参加过伊拉克和阿富汗冲突的人员。初步研究 显示退伍军人管理局机构入学率差异很大，但我们没有退伍军人管理局差异的数据 设施信赖率。此外，我们不了解是什么导致了这些差异。尽管有 对个人(例如，年龄)和社区层面(例如，非退伍军人管理局提供的)因素有一定的了解 影响退伍军人管理局注册和使用，我们缺乏对设施因素的了解，这些因素可以修改为 适当地将退伍军人与退伍军人和此后所需的服务联系起来。 具体目标：研究计划有三个主要目标：1)了解哪些信息和资源 设施和VISN领导者需要更好地了解和管理 初级和精神卫生保健；2)通过评估下列因素之间的关系获得对设施因素的洞察力 初级和精神卫生保健的入学率、依赖率、获得保健的机会和护理质量；以及3) 开发或修改现有信息工具(S)，以协助设施和VISN领导管理注册和 初级和精神卫生保健的依赖率。 方法：本CDA旨在填补对小学和高中入学和依赖的理解空白 通过混合方法提供精神卫生保健：产生关于设施注册的描述性数据 和信任率(目标1.1)；定性研究退伍军人对其招生决定的见解 在涉及退伍军人管理局参与者和非参与者的访谈中的依赖(目标1.2)；约谈退伍军人管理局领导人关于 他们关于注册和依赖的信息需求(目标1.3)；使用分层建模来理解 关于入学和质量的哪些可修改的设施因素与入学率和信赖率有关(目标2)； 以及开发、测试和实施工具，以帮助退伍军人管理局领导人提高注册和信赖率 (目标3)。 下一步/实施：研究结果将帮助退伍军人管理局医疗保健领导层实现其目标变化 可以管理退伍军人在退伍军人医疗系统中的登记和保留，并提供所需的 基础性服务。结果还将为我未来在信息和资源分配工具方面的工作提供参考 支持退伍军人和领导决策。

Background: This CDA will provide me, Megan E. Vanneman, PhD, MPH, with the training and experience to become an independent health services researcher who applies decision science and informatics to improve Veterans’ access to and engagement in high-quality care. To help achieve this goal, I will work with my mentors, consultants, and operational partners to develop and evaluate an information and decision support tool to improve VA leaders’ understanding and decision-making about VA enrollment and reliance (proportion of care received at VA) on primary and mental health care. Significance/Impact: This research will have a positive impact on VA leaders, Veterans interested in enrolling in VA health care, and Veterans needing primary and mental health care, by increasing understanding of how access, quality, enrollment, and reliance can be optimized to better meet Veterans’ needs. As the VA moves from a more closed, integrated healthcare system to providing care through networks that include community partners, VA leaders need to better understand enrollment, reliance, access, and quality at their local facilities and VISNs, particularly for “foundational services,” such as primary and mental health care. The CDA strongly aligns with top VA priorities – increasing choice for Veterans, modernizing the VA system, using VA resources more efficiently, and improving timeliness of services. Innovation: While we know that about 50% of Veterans enroll in VA and that about 50% of care for these enrollees is provided in the VA, we have little understanding of what drives these decisions for recently separated Servicemembers – those who participated in conflicts in Iraq and Afghanistan. Preliminary studies show that there is wide variation in VA facility enrollment rates, but we do not have data on variation in VA facility reliance rates. Furthermore, we do not understand what drives these differences. Although there is some understanding of individual (e.g., age) and community-level (e.g., non-VA provider supply) factors that influence VA enrollment and utilization, we lack understanding of facility factors that can be modified to appropriately connect Veterans to VA and needed services thereafter. Specific Aims: The research plan has three primary goals: 1) Learn what information and resources VA facility and VISN leaders need to better understand and manage enrollment rates and reliance rates for primary and mental health care; 2) Derive insights on facility factors by evaluating relationships among enrollment rates, reliance rates, access to care, and quality of care for primary and mental health care; and 3) Develop or modify existing information tool(s) to assist facility and VISN leaders to manage enrollment and reliance rates for primary and mental health care. Methodology: This CDA seeks to fill the gap in understanding on enrollment and reliance for primary and mental health care through a mixed-methods approach by: producing descriptive data on facility enrollment and reliance rates (Aim 1.1); qualitatively studying Veterans’ insights on their decisions regarding enrollment and reliance in interviews involving VA enrollees and non-enrollees (Aim 1.2); interviewing VA leaders about their information needs regarding enrollment and reliance (Aim 1.3); using hierarchical modeling to understand what modifiable facility factors on access and quality are associated with enrollment and reliance rates (Aim 2); and developing, testing, and implementing a tool to assist VA leaders to improve enrollment and reliance rates (Aim 3). Next Steps/Implementation: Study results will help VA healthcare leadership target changes that they can make to manage enrollment and retention of Veterans in the VA healthcare system and deliver needed foundational services. Results will also inform my future work on information and resource allocation tools to support Veterans’ and leaders’ decision making.