Veteran Interactions with VA Primary Care Prior to Suicide

对退伍军人医疗保健的预期影响：研究结果有可能1）确定初级保健环境中识别和治疗自杀完成高风险退伍军人的差距和障碍，2）确定VA初级保健中与高风险相关的患者的具体特征， 自杀完成，3）确定与接受自杀预防相关护理相关的患者，提供者和系统特征，以及4）根据持久自由行动/伊拉克自由行动（OEF/OIF）退伍军人的独特需求制定医疗保健和自杀预防工作。 项目背景：此前的研究表明，退伍军人自杀的可能性是非退伍军人的两倍，每年有多达6,500名退伍军人自杀。许多患者在自杀前会去看医生。初级保健临床医生可能处于一个独特的位置来干预这些患者。不幸的是，很少有人知道的特点，病人谁接触初级保健临床医生自杀前，以及这些病人与临床医生的互动的内容。因此，目前还不清楚在初级保健中存在哪些机会来干预自杀风险最高的个人。 项目目标：该项目的目标是通过描述和评估退伍军人自杀死者在死亡前一年接受的退伍军人初级保健来告知退伍军人自杀预防策略。具体来说，我们将1）描述的特点，并接受医疗保健的自杀死者在弗吉尼亚州的初级保健设置 在死亡前一年，并将此医疗保健与未完成自杀的退伍军人的匹配样本所接受的医疗保健进行比较; 2）评估退伍军人自杀死者与VA初级保健团队的最后互动内容; 3）描述OEF/OIF退伍军人自杀死者的特征和VA初级保健，并将这些特征和护理与其他退伍军人患者进行比较 组 研究方法：本研究为回顾性描述性病例对照研究。我们将把来自10个州的国家暴力死亡报告系统数据（NVDRS）与退伍军人管理局决策支持系统（DSS）联系起来，以确定2005年至2009年完成自杀的退伍军人，以及在死亡前12个月内接受退伍军人管理局医疗保健的退伍军人。NVDRS数据包括人口统计信息（包括患者标识符）、死亡方式和其他 变量DSS将提供额外的人口统计学、临床（一般医学和精神病诊断）和医疗保健利用（访视类型和次数、药物）数据。“持久自由行动”/“伊法组织名册将用于确定”持久自由行动“/”伊法组织的地位，并将为“持久自由行动”/“伊法组织退伍军人分组提供军事历史信息。我们 将使用VA VistAWeb进行病历审查，以访问参与州内所有VA研究中心的个人病历（包括病程记录），并收集有关医疗访视内容的信息。医疗记录审查变量包括临床医生是否筛查或评估抑郁症，物质使用障碍，创伤后应激障碍，自杀意念，易感性和 自杀的保护因素，最后一次接触的原因，以及最后一次接触时存在的情绪困扰。 分析将按性别分层。我们将总结人口统计学和临床特征，描述初级保健团队评估的变量，以及为完成自杀的退伍军人采取的临床行动。我们将比较自杀死者的特征和接受的医疗保健与1：1的对照样本 年龄，性别，和初级保健提供者匹配的退伍军人谁没有完成自杀。标准误差的稳健估计将用于调整州内的聚类。将针对初步分析中确定的协变量调整回归模型。我们还将比较的特点和医疗保健收到 OEF/OIF退伍军人与1：2匹配的对照样本（1）其他完成自杀的退伍军人和2）未完成自杀的OEF/OIF退伍军人。

Anticipated Impacts on Veterans' Healthcare: Study results have the potential to 1) identify gaps and barriers within the primary care setting in the identification and treatment of veterans at high risk for suicide completion, 2) identify specific characteristics of patients seen in VA primary care that are associated with high risk of suicide completion, 3) identify patient, provider and system characteristics that are associated with receipt of care related to suicide prevention, and 4) shape healthcare and suicide prevention efforts to the unique needs of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans. Project Background: Prior research suggests that veterans are twice as likely to die by suicide compared to non-veteran civilians, and each year, as many as 6,500 veterans take their own lives. Many patients visit healthcare clinicians prior to suicide. Primary care clinicians may be in a unique position to intervene with these patients. Unfortunately, little is known about the characteristics of patients who make contact with primary care clinicians prior to suicide, as well as the content of these patient-clinician interactions. It is thus unclear what opportunities may exist within primary care for intervening with individuals at highest risk for suicide. Project Objectives: The goal of this project is to inform VA suicide prevention strategies by describing and evaluating the VA primary care received by veteran suicide decedents in the year prior to death. Specifically, we will 1) describe characteristics of, and healthcare received by suicide decedents in VA primary care settings in the year prior to death, and compare this healthcare to healthcare received by a matched sample of veterans who did not complete suicide; 2) evaluate content of last interactions of veteran suicide decedents with VA primary care teams; and 3) describe characteristics of, and VA primary care received by OEF/OIF veteran suicide decedents and compare these characteristics and care to those of other veteran patient groups. Project Methods: This is a retrospective descriptive and case-control study. We will link National Violent Death Reporting System Data (NVDRS) from 10 States with the VA Decision Support System (DSS) to identify veterans who completed suicide from 2005 to 2009 and who received VA healthcare in the 12 months prior to death. NVDRS data include demographic information (including patient identifiers), means of death, and other variables. DSS will provide additional demographic, clinical (general medical and psychiatric diagnoses), and healthcare utilization (types and numbers of visits, medications) data. The OEF/OIF Roster will be used to identify OEF/OIF status and will provide military history information for the subgroup of OEF/OIF veterans. We will conduct medical record review using VA VistAWeb to access individual medical records (including progress notes) from all VA sites within participating states, and gather information on the content of healthcare visits. Medical record review variables include whether clinicians screened or assessed for depression, substance use disorder, post-traumatic stress disorder, suicidal ideation, predisposing and protective factors for suicide, reasons for last contacts, and presence of emotional distress at last contacts. Analyses will be stratified by sex. We will summarize demographic and clinical characteristics, variables describing primary care team assessments, and clinical actions taken for veterans who completed suicide. We will compare characteristics of, and healthcare received by, suicide decedents to those of a 1:1 control sample of age, sex, and primary care provider-matched veterans who did not complete suicide. Robust estimates of the standard errors will be used to adjust for clustering within states. Regression models will be adjusted for covariates identified in preliminary analyses. We will also compare characteristics of and healthcare received by OEF/OIF veterans to 1:2 matched control samples of 1) other veterans who completed suicide, and 2) OEF/OIF veterans who did not complete suicide.