Quantifying the Burden of Disease and Healthcare Need in Veterans and Civilians

背景：随着退伍军人在社区中对护理的使用迅速加快，用于准备的数据有限 社区提供者和退伍军人管理局更广泛的综合护理网络中的其他人。许多社区提供商和 健康计划可能假设退伍军人与他们的常规实践人群相似，主要由 虽然先前的研究表明情况并非如此。 重要性/影响：拟议的研究将使用来自 行为危险因素监测系统(BRFSS)，国家健康访谈调查(NHIS)，国家 药物使用与健康调查(NSDUH)和退伍军人事务部企业数据仓库(CDW)，以广泛量化 退伍军人、退伍军人和退伍军人非退伍军人的健康和保健因素分布情况，并进行深入评估 退伍军人和平民之间的不同因素。这些信息不仅将大幅更新我们的 退伍军人与平民的相似或不同之处的知识，但退伍军人政策制定者也将利用这些知识 随着退伍军人管理局转诊人数的增加，改善社区护理合作伙伴的设计和准备情况。 创新：与以前使用国家调查数据的研究和报告不同，拟议的项目将 包括VA数据以提供比仅使用公共可用数据更丰富的VA患者的描述 关于退伍军人的用户，并深入检查退伍军人的健康和医疗保健在子组和以上的模式 时间到了。拟议的研究在VA HSR&D或QUERI的投资组合中没有推论或前因性研究，并且 在退伍军人事务部之外资助的使用一个或多个这些来源并且正在进行或最近正在进行的研究 已完成，没有人提议使用退伍军人事务部数据或将拟议项目的广度和深度结合起来 具体目标：本项目旨在1.量化人群特征、健康行为、 退伍军人的健康状况、健康状况、获得护理的机会和医疗保健利用情况 VA使用者和非使用者；2.评估人口、健康和医疗保健模式在多大程度上 退伍军人和平民之间的相关因素不同；3.确定目标1下确定的模式 和2.根据年龄、性别和种族-民族定义的子组不同；和4.领导一个专家小组审查 目标1-3的结果将就改善社区的循证建议达成共识 护理(例如，社区提供者的就绪性)和健康公平。 方法：我们将使用来自BRFSS，NHIS， NSDUH和VA CDW。我们的分析将包括针对退伍军人和退伍军人管理局用户状态、地理位置 地区、人口特征、健康行为和条件，以及医疗保健结果，如可获得性、 使用率和未得到满足的护理需求。我们将量化人口、健康和医疗保健的分布- 退伍军人、退伍军人和退伍军人非退伍军人中的相关因素，评估这些因素在 退伍军人和平民，评估退伍军人使用退伍军人和退伍军人之间差异的程度 并评估退伍军人在不同人口亚群中的模式有何不同。我们将使用改装的 Delphi专家组方法对研究结果进行批判性评估，对其重要性、可行性和对退伍军人的潜力进行评级 影响，并就社区护理和卫生公平的循证建议达成共识。 下一步/实施：我们将让不同的利益攸关方担任顾问/小组成员(例如，国家 计划办公室、VISN、VAMC和资深代表)设计传播产品(如FACT 表格、视觉摘要)，除了传统的科学技术外，还能满足终端用户的需求 产品。专家小组过程中将明确规划能够提供信息和 支持潜在的做法和政策变化及其随后的实施。

Background: With rapid acceleration of Veterans’ use of care in the community, limited data exist to prepare community providers and others in the broader VA integrated care network. Many community providers and health plans may assume Veteran patients are similar to their routine practice populations, composed primarily of civilians, although prior research would suggest otherwise. Significance/Impact: The proposed study will use detailed, current, and comprehensive data from the Behavioral Risk Factor Surveillance System (BRFSS), National Health Interview Survey (NHIS), the National Surveys on Drug Use and Health (NSDUH), and VA Corporate Data Warehouse (CDW) to quantify broadly the distribution of health and healthcare factors for Veterans, VA users, and VA non-users and to evaluate in-depth the factors that differ between Veterans and civilians. This information will not only substantially update our knowledge of how Veterans are similar to or different from civilians but will also be used by VA policymakers to improve the design and readiness of community care partners as VA referrals increase. Innovation: In contrast to previous studies and reports using national survey data, the proposed project will include VA data to provide a richer description of VA patients than is possible using only publicly-available data on VA users, and examine in depth the patterns in Veterans’ health and healthcare across subgroups and over time. The proposed research has no corollary or antecedent study in VA HSR&D’s or QUERI’s portfolio, and of the studies funded outside the VA that use one or more of these sources and is underway or recently completed, none proposed to use VA data or to combine the breadth and depth of the proposed project Specific Aims: This project aims to 1. Quantify the distribution of population characteristics, health behaviors, health conditions, health status, access to care, and healthcare utilization among Veterans overall and among VA users and non-users; 2. Evaluate the extent to which patterns in population-, health-, and healthcare- related factors differ between Veterans and civilians; 3. Determine whether the patterns identified under Aims 1 and 2 vary for subgroups defined by age, gender, and race-ethnicity; and, 4. Conduct an expert panel to review results from Aims 1-3 to come to consensus on evidence-based recommendations for improved community care (e.g., community provider readiness) and health equity. Methodology: We will conduct a secondary analysis using multiple years of data from BRFSS, NHIS, NSDUH, and VA CDW. Our analyses will include measures for Veteran and VA user status, geographic region, population characteristics, health behaviors and conditions, and healthcare outcomes, such as access, utilization, and unmet need for care. We will quantify the distribution of population-, health-, and healthcare- related factors among Veterans, VA users, and VA non-users, evaluate how these factors differ between Veterans and civilians, assess the extent to which VA use moderates differences between Veterans and civilians, and assess how patterns for Veterans differ across population subgroups. We will use modified Delphi panel methods to critically appraise findings, rate their importance, feasibility, and potential for Veteran impacts, and come to consensus on evidence-based recommendations for community care and health equity. Next Steps/Implementation: We will engage diverse stakeholders as advisors/panelists (e.g., national program office, VISN, VAMC and Veteran representatives) in design of dissemination products (e.g., fact sheets, visual abstracts) for different venues that meet end user needs in addition to traditional scientific products. Integrated into the panel process will be explicit planning for products capable of informing and supporting potential practice and policy changes and their subsequent implementation.