Developing Cross-Sector Collaborations to Meet the Social Needs of Veterans

一个由退伍军人事务部HSR&D资助的多方利益相关者工作组确定了支持退伍军人管理局目标的研究方法 解决退伍军人未得到满足的社会需求。工作组确定了退伍军人管理局的孤岛性质，即缺乏 发现退伍军人症患者并将其与非退伍军人事务部社会服务联系起来的有效模式，证据不足 以医疗保健为基础的社会需求干预对健康的影响是可以解决的三个障碍 通过研究。这项混合方法的试点研究将开始通过建立以下伙伴关系来解决这些差距 研究团队、相关退伍军人管理局和一个一直在开发多部门的组织 自2015年以来，为增加退伍军人获得卫生和社会服务的机会而建立的网络。通过他们的美国服务 在这项倡议中，退伍军人和军人家属研究所(IVMF)建立了公共和私人的协调网络 支持退伍军人的组织。他们的服务广度、综合护理协调方法以及 以军事为中心的焦点使americaServes成为退伍军人管理局医疗机构加入以增加 退伍军人获得非退伍军人事务部社会服务。尽管有潜在的好处，但对americaServes的初步分析 客户数据和与IVMF、退伍军人体验办公室和其他退伍军人方案办公室的沟通， 指出退伍军人管理局医疗机构是否以及如何参与americaServes Network或类似服务的广泛差异 协作。这种参与对退伍军人健康相关结果的影响也是未知的。 这项研究的总体目标是扩大指导退伍军人管理局参与的证据基础 协作机构中的设施，如americaServes。作为关键的第一步，该项目将确定退伍军人管理局医疗 目前参与americaServes网络的设施和阻碍或促进合作的因素 跨组织。该项目还将建立将americaServes和退伍军人管理局行政数据联系起来，以确定 增加协作的机会领域，并为确定此类影响奠定基础 在未来研究中就退伍军人健康相关结果进行合作。该项目有三个具体目标。 目标1是描述正式和非正式的水平、障碍和促进者 退伍军人管理局医疗机构参与americaServes网络。以希梅尔曼的发展观为指导 变革战略连续体对于组织间协作，团队将进行半结构化 对来自americaServes网络和退伍军人医疗机构样本的关键线人进行了采访。快速 定性分析将用于比较不同参与程度的障碍和促进者。 目标2是确定americaServes客户的数量、百分比和特征 接受退伍军人管理局医疗机构的服务。AmericaServes所有2019年americaServes客户的数据将 与退伍军人管理局管理数据源的社会人口学和临床数据合并，以识别服役的退伍军人 由这两个组织提供。重叠地区退伍军人的人口学、临床和服务利用特征 组将与仅由退伍军人或仅由美国军人服役的退伍军人进行比较。 目标3是制定利益相关者知情的建议，以指导退伍军人医疗的参与 社区社会服务网络中的设施(例如，americaServe)。联合展示将用于 整合和总结退伍军人事务部定性(目标1)和定量(目标2)分析的结果 加入americaServes Networks。调查结果将与利益相关者参与小组讨论 包括来自IVMF、退伍军人计划办公室的代表，以及来自社区退伍军人参与的退伍军人 冲浪板。这些讨论将用于确定在以下方面增强协作的机会领域 并制定建议，以指导退伍军人医疗机构未来参与社区- 以社会服务网络为基础。这项试点研究的合作伙伴关系、发现和建议将为 未来的观察性和试验性研究考察了与社区社会服务合作的影响 将退伍军人医疗机构中的退伍军人与非退伍军人健康社会服务联系起来的服务网络。

A VA HSR&D-funded multi-stakeholder workgroup identified ways in which research could support the VA’s goal of addressing Veterans’ unmet social needs. The workgroup identified the siloed nature of VA, the lack of effective models for finding and connecting VA patients with non-VA social services, and insufficient evidence on the health impact of healthcare-based social needs interventions as three barriers that could be addressed by research. This mixed methods pilot study will begin to address these gaps by building partnerships between the research team, relevant VA program offices, and an organization that has been developing multi-sector networks to increase Veteran access to health and social services since 2015. Through their AmericaServes Initiative, the Institute for Veterans and Military Families (IVMF) builds coordinated networks of public and private organizations to support Veterans. Their breadth of services, wraparound care coordination approach, and military-centric focus make AmericaServes a promising collaborative for VA medical facilities to join to increase Veteran access to non-VA social services. Despite the potential benefits, preliminary analyses of AmericaServes client data and communication with IVMF, the Veterans Experience Office, and other VA program offices, indicate wide variation in whether and how VA medical facilities participate in AmericaServes Networks or similar collaboratives. The impact of such participation on Veteran health-related outcomes is also unknown. The overall objective of this research is to grow the evidence base needed to guide participation of VA medical facilities in collaboratives such as AmericaServes. As a critical first step, this project will identify how VA medical facilities currently participate in AmericaServes Networks and factors that impede or facilitate collaboration across organizations. The project will also establish link AmericaServes and VA administrative data to identify areas of opportunity for increased collaboration and lay the groundwork for determining the impact of such collaboration on Veteran health-related outcomes in future studies. The project has three specific aims. Aim 1 is to characterize the level of, as well as the barriers to and facilitators of, formal and informal participation of VA medical facilities in AmericaServes Networks. Guided by Himmelman’s Developmental Continuum of Change Strategies for inter-organizational collaboration, the team will conduct semi-structured interviews with key informants from a sample of AmericaServes Networks and VA medical facilities. Rapid qualitative analysis will be used to compare the barriers to and facilitators of different levels of participation. Aim 2 is to identify the number, percentage, and characteristics of AmericaServes clients who also receive services from VA medical facilities. AmericaServes data on all 2019 AmericaServes clients will be merged with sociodemographic and clinical data from VA administrative data sources to identify Veterans served by both organizations. Demographic, clinical, and service utilization characteristics of Veterans in the overlapping group will be compared with Veterans served only by VA or only by AmericaServes. Aim 3 is to develop stakeholder-informed recommendations to guide participation of VA medical facilities in community-based social service networks (e.g., AmericaServes). Joint displays will be used to integrate and summarize findings from the qualitative (Aim 1) and quantitative (Aim 2) analyses of VA participation in AmericaServes Networks. Findings will be discussed with a Stakeholder Engagement Panel including representatives from IVMF, VA program offices, and Veterans from Community Veteran Engagement Boards. These discussions will be used to identify areas of opportunity for increased collaboration across organizations and to develop recommendations to guide future participation of VA medical facilities in community- based social service networks. The partnerships, findings, and recommendations from this pilot study will inform future observational and experimental studies examining the impact of working with community-based social service networks to connect Veterans in VA medical facilities to non-VA social services on Veteran health.