Serving All Who Have Served: Enhancing Suicide-Related Care Quality for Black, Indigenous, and People of Color Veterans

背景：预防退伍军人自杀仍然是退伍军人健康管理局的首要临床任务 （VHA）。为了减轻退伍军人自杀风险，VHA制定了国家指导方针，建议加强护理包 自我导向暴力（SDV）后，如创建自杀安全计划或增加门诊频率 心理健康访问。坚持每一个给定的护理组成部分被认为是自杀护理质量的标志 风险（以下简称自杀相关护理质量）。利用国家VHA数据的最新研究 这表明这些护理成分可能不会公平地提供给所有退伍军人。研究表明，布莱克， 原住民和有色人种（BIPOC）退伍军人的精神卫生保健质量比白色人差 对于退伍军人来说，类似的问题可能会影响他们与自杀相关的护理质量。然而，没有研究 日期已经检查了BIPOC退伍军人中自杀相关护理的质量。因此，进一步评价 自杀相关的护理质量是必要的，以确保公平，有效的照顾BIPOC退伍军人与SDV。的 目前的提案旨在评估BIPOC退伍军人中自杀相关护理质量的组成部分， 同时，混合方法三角测量方法，为未来的干预发展提供信息。 意义：拟议的项目直接解决VHA的首要临床优先事项，自杀预防。在 此外，这一建议也与弗吉尼亚州卫生和社会研究与发展部的自杀预防和健康公平的高度优先重点相一致 作为VHA国家战略计划目标2.1和2.3，重点是确保退伍军人得到公平， 提供全面的预防自杀服务，以协助他们康复。VHA健康公平和VHA办公室 心理健康和自杀预防办公室还在其战略计划中强调， 为所有退伍军人提供平等的自杀相关护理。 创新和影响：拟议的项目是BIPOC对自杀相关护理质量的首次评估 退伍军人与SDV。此外，迄今为止还没有研究确定提高自杀相关护理质量的领域 BIPOC退伍军人使用与BIPOC Veteran进行三角测量的国家VHA和非VHA管理数据 心理健康临床医生的定性数据将导致对当前影响因素的更丰富的概念化， 与自杀有关的护理，并为今后加强护理的战略提供信息。 具体目标：目标1）评估BIPOC退伍军人中与自杀相关的护理质量;目标2）进行定性 采访BIPOC退伍军人和VA临床医生，以更好地了解影响自杀相关护理的因素 BIPOC退伍军人的质量;目的3）探索卫生保健系统水平因素与自杀之间的关联- BIPOC退伍军人的相关护理质量指标;探索性目的）探索自杀与 BIPOC退伍军人和自杀结果之间的相关护理质量。 方法：目标1将利用VHA数据库识别患有SDV（FY 18-FY 22）的BIPOC退伍军人。数据从 VHA公司数据仓库，用于自杀相关的护理质量结果以及社会人口统计学和 临床变量将被链接。将使用广义估计方程分析数据。目标2将涉及 采访至少40名BIPOC退伍军人和至少40名VHA心理健康临床医生，了解他们的信仰， 与自杀相关的护理经验，将使用主题分析进行分析。Aim 3将连接来自 目标1：站一级的卫生保健系统因素。对于探索性目的，将数据与死亡率数据联系起来 来源，以探索与死亡率结果的关联。 下一步/实施：拟议的项目将增加我们对自杀影响因素的了解- BIPOC退伍军人的相关护理质量。该项目的调查结果将为今后的提案提供参考， 发展干预措施，以提高BIPOC退伍军人中与自杀有关的护理质量。

Background: Veteran suicide prevention remains the top clinical priority for the Veterans Health Administration (VHA). To mitigate Veteran suicide risk, VHA has national guidelines recommending an enhanced care package after self-directed violence (SDV) such as creating a suicide safety plan or increasing the frequency of outpatient mental health visits. Adherence to each given care component is considered a marker of care quality for suicide risk (henceforth referred to as suicide-related care quality). Recent research utilizing national VHA data suggests these care components may not be provided equitably to all Veterans. As research shows that Black, Indigenous, and People of Color (BIPOC) Veterans experience poorer mental health care quality than white Veterans, it is possible that similar issues may impact their suicide-related care quality. However, no research to date has examined the quality of suicide-related care among BIPOC Veterans. Thus, further evaluation of suicide-related care quality is needed to ensure equitable, effective care for BIPOC Veterans with SDV. The current proposal seeks to evaluate components of suicide-related care quality among BIPOC Veterans using a concurrent, mixed-methods triangulation approach to inform future intervention development. Significance: The proposed project directly addresses VHA’s top clinical priority, suicide prevention. In addition, this proposal aligns with VA HSR&D’s high priority foci of suicide prevention and health equity as well as VHA National Strategic Plan Objectives 2.1 and 2.3 which focus on ensuring Veterans receive equitable, comprehensive suicide prevention services to support their recovery. VHA Office of Health Equity and VHA Office of Mental Health and Suicide Prevention also highlight in their strategic plans the need for supporting equitable, suicide-related care for all Veterans. Innovation and Impact: The proposed project is the first evaluation of suicide-related care quality among BIPOC Veterans with SDV. In addition, no research to date has determined areas to improve suicide-related care quality for BIPOC Veterans. Use of national VHA- and non-VHA administrative data triangulated with BIPOC Veteran and mental health clinician qualitative data will result in a richer conceptualization of current factors impacting suicide-related care and inform future strategies for enhancing care. Specific Aims: Aim 1) Evaluate suicide-related care quality among BIPOC Veterans; Aim 2) Conduct qualitative interviews with BIPOC Veterans and VA clinicians to better understand factors impacting suicide-related care quality for BIPOC Veterans; Aim 3) Explore associations between health care systems-level factors and suicide- related care quality indicators for BIPOC Veterans; Exploratory Aim) Explore the relationship between suicide- related care quality among BIPOC Veterans and suicide outcomes. Methodology: Aim 1 will identify BIPOC Veterans with SDV (FY18-FY22) utilizing VHA databases. Data from the VHA Corporate Data Warehouse for suicide-related care quality outcomes as well as sociodemographic and clinical variables will be linked. Data will be analyzed using generalized estimating equations. Aim 2 will involve interviews with at least 40 BIPOC Veterans and at least 40 VHA mental health clinicians about their beliefs and experiences with suicide-related care which will be analyzed using thematic analysis. Aim 3 will link data from Aim 1 to health care systems factors at the station level. For the Exploratory Aim will link data from mortality data sources to explore associations with mortality outcomes. Next Steps/ Implementation: The proposed project will increase our understanding of factors impacting suicide- related care quality among BIPOC Veterans. Findings from this project will inform future proposals focused on intervention development to enhance suicide-related care quality among BIPOC Veterans.