Eating Disorder Screening and Diagnostic Tools for the Veteran Healthcare System

进食障碍是一种严重的精神障碍，与一系列重要的健康状况有关 问题，包括高死亡率和自杀率。最近的一项系统审查发现， 退伍军人和现役军人的饮食失调与患病率相当或高于患病率 对一般人口的估计。我们的试验数据以及其他人公布的数据表明， 15%-25%的退伍军人在接受评估时符合饮食失调的诊断标准，相比之下，退伍军人的这一比例 显示饮食失调的电子医疗记录数据被低估了。同时， 退伍军人健康管理局(VHA)中患有进食障碍的退伍军人比例正在增加，原因是 几个因素，包括越来越多的女性参军，饮食失调的扩大 诊断标准，以及越来越多的退伍军人受到饮食失调风险因素的影响 具有军事生活特点的。尽管饮食失调不被认为是与服务相关的疾病，但可能 也影响到男性退伍军人，在部队期间压力大的条件下不良的饮食习惯会设置 男女军人饮食行为紊乱的基础和退伍后体重增加的轨迹 退伍军人。目前，还没有VHA推荐的饮食障碍筛查或诊断指南。 因此，退伍军人的饮食失调可能没有被发现，导致治疗不足或延迟， 在最坏的情况下，过早死亡。饮食失调的识别和治疗已被确定为 来自心理健康的设施级利益攸关方的首要任务。作为回应，VHA精神健康服务和 妇女健康服务机构正在传播一项多学科饮食护理的临床医生培训计划 精神错乱。虽然最终目标是在全国范围内实施这项培训，但卫生服务面临的挑战是如何 最好地建立包括有针对性的筛查和诊断的临床路径，以最好地识别退伍军人 需要这种特殊护理的人。我们的目标是开发一种基于证据的临床路径来识别进食 退伍军人群体中的疾病，将有助于标准化护理和改善退伍军人的结局。 我们将使用具有三个具体目标的混合方法。第一个目标将是进一步发展和 验证DSM-5的初级保健饮食障碍筛查，该筛查适用于退伍军人。第二个目标 将验证饮食失调的自我报告测量，该测量评估所有DSM-5诊断标准和 对于退伍军人来说是可以概括的。第三个目标是评估如何最好地实施筛选和测量 在整个VHA进行临床实践。在我们的定量研究(目标1和目标2)中，我们将从旧金山招募退伍军人 弗朗西斯科弗吉尼亚州医疗系统和弗吉尼亚州康涅狄格州医疗系统。退伍军人(N=400)将完成一项 一系列问卷调查以确定进食障碍症状。具有和不具有的随机子集 可能的进食障碍(n=156)将被邀请参加黄金标准的诊断临床访谈，以 验证建议的筛查和自我报告措施，以全面诊断进食障碍。在……里面 为了重新验证筛选，我们随后将从全国退伍军人样本中招募退伍军人 完成建议的筛查和自我报告诊断措施(N=400)。同时为我们的定性 研究(目标3)，我们将采访利益相关者(N=38；VHA患者、提供者和领导者)，以了解如何最好地 在多个VHA用户入口点实施筛查和自我报告诊断措施(初级保健、 心理健康、妇女诊所和退伍军人管理局国家体重管理计划，Move！)我们的目标将 允许我们通过合作工作和利益相关者反馈来填补空白，并帮助建立一条临床路径 找出那些可能陷入困境，没有得到所需护理的退伍军人。这个项目 符合与VHA卓越蓝图一致的几项战略，包括满足 退伍军人的需求，提供了一条“高质量、以退伍军人为中心的关怀”的临床路径，并“引领 国家在研究和治疗与服兵役相关的条件。

Eating disorders are serious psychiatric disorders that are associated with a range of significant health problems, including elevated mortality and suicide rates. A recent systematic review found prevalence rates of eating disorders among Veteran and Service Members to be comparable to or higher than prevalence estimates for the general population. Our pilot data, as well as published data by others, has demonstrated that 15-25% of Veterans meet diagnostic criteria for eating disorders when assessed, in contrast to Veteran electronic medical record data that reveals eating disorders are underdiagnosed. At the same time, the proportion of Veterans in the Veterans Health Administration (VHA) with eating disorders are increasing due to several factors, including the growing number of women in the military, expansions of eating disorder diagnostic criteria, and increasing numbers of Veterans affected by risk factors for eating disorders that are characteristic of military life. Although eating disorders are not thought of as service-related conditions that may also impact male Veterans, poor eating habits under stressful conditions while in the military can set the foundation for disordered eating behavior and trajectories of weight gain post-military in both female and male Veterans. Currently, there are no VHA recommended guidelines for eating disorder screening or diagnosis. Consequently, eating disorders in Veterans may be undetected, resulting in insufficient or delayed treatment, and in the worst case, premature death. Eating disorders identification and treatment has been identified as a top priority by facility-level stakeholders from mental health. In response, VHA Mental Health Services and Women’s Health Services are disseminating a clinician training program for the multidisciplinary care of eating disorders. While the ultimate goal is to implement this training nationwide, the health services challenge is how to best establish a clinical pathway that includes targeted screening and diagnosis to best identify Veterans who need this specialty care. Our goal is to develop an evidence-based clinical pathway to identify eating disorders in the Veteran population that will aid in standardizing care and improving outcomes for Veterans. We will use a mixed methods approach with three specific aims. The first aim will be to further develop and validate a primary care eating disorder screen for DSM-5 that is generalizable for Veterans. The second aim will be to validate a self-report measure of eating disorders that assesses for all DSM-5 diagnostic criteria and is generalizable for Veterans. The third aim will be to assess how to best implement the screen and measure across VHA for clinical practice. In our quantitative study (Aims 1 and 2), we will recruit Veterans from the San Francisco VA Healthcare System and VA Connecticut Healthcare System. Veterans (N=400) will complete a series of questionnaires to identify eating disorder symptoms. A random subset of those with and without probable eating disorders (n=156) will be invited to participate in a gold-standard diagnostic clinical interview to validate the proposed screen and self-report measure for the full spectrum of eating disorder diagnoses. In order to revalidate the screen, we will subsequently recruit Veterans from a national Veteran sample to complete the proposed screen and self-report diagnostic measure (N=400). Concurrently for our qualitative study (Aim 3), we will interview stakeholders (N=38; VHA patients, providers, and leaders) on how to best implement the screen and self-report diagnostic measure across multiple VHA-user entry points (Primary Care, Mental Health, Women’s Clinic, and the VA National Weight Management Program, MOVE!). Our aims will allow us to fill a gap through partnered work and stakeholder feedback, and help build a clinical pathway to identify Veterans that may be falling through the cracks and not getting the care that they need. This project meets several strategies consistent with the VHA Blueprint for Excellence including meeting the “unique needs” of Veterans, providing a clinical pathway for “high quality, Veteran-centered care,” and “leading the nation in research and treatment of military service-related conditions.”