Chronic Tinnitus among Veterans with and without TBI: Service Needs and Interests

 描述（由申请人提供）： 项目背景/依据：耳鸣在退伍军人中很常见，特别是那些有创伤性脑损伤（TBI）史的人，并可能导致严重的认知，情绪或睡眠障碍。2013年，超过110万VA注册的退伍军人因耳鸣而获得服务。耳鸣是一种终生的疾病，没有“治愈”的方法。“然而，我们的团队已经开发了渐进式耳鸣管理（PTM），一个旨在亲自或通过电话提供的程序，教退伍军人（有和没有TBI）管理耳鸣症状的方法。在随机对照试验中，基于临床和基于电话的PTM导致耳鸣相关痛苦和功能障碍的临床显著减少。因此，将循证PTM转化为常规临床实践是当务之急。我们正在进行研究，以了解跨VA站点PTM摄取的障碍。初步研究结果表明：1）具有全面TBI服务的站点可能更愿意实施PTM;但是，2）所有站点都缺乏支持耳鸣退伍军人对PTM的需求和兴趣的数据。项目目标：该项目将通过检查VA护理系统中退伍军人中临床显著耳鸣的流行病学来解决这一差距。具体来说，我们的目标是：1）确定需要临床服务的耳鸣退伍军人的比例; 2）检查退伍军人对PTM的兴趣，无论是基于诊所还是基于电话; 3）通过TBI历史评估退伍军人的需求和兴趣差异。项目方法：这个为期两年的项目将采用顺序混合方法研究设计。在第一阶段，我们将对1,200名随机抽样的退伍军人进行调查，这些退伍军人被确定患有耳鸣，并按TBI病史分层。调查将使用修改后的Dillman方法邮寄，并将收集有关退伍军人耳鸣症状，严重程度和功能障碍的信息;对PTM的兴趣和看法;以及整体健康和功能。在第二阶段，将对部分调查受访者进行半结构化电话访谈，这些受访者是根据调查问题的回答模式有目的地抽样调查的。访谈将解决退伍军人的耳鸣症状和功能障碍;与耳鸣相关的医疗保健的经验;和兴趣和感知的障碍，以接受PTM。调查和访谈数据将与VA行政数据进行三角测量，以充分了解退伍军人对PTM服务的需求和兴趣。预期影响：耳鸣对退伍军人来说是一个越来越重要的问题，特别是那些有TBI病史的人。PTM在减少耳鸣相关功能障碍方面非常有效，但VA领导者和临床医生需要经验数据来支持其实施。我们的研究结果将直接解决这一需求，通过生成关于需要PTM服务的退伍军人数量的背景化（定量和定性）数据，他们在接受这些服务时的兴趣，以及推动他们表达需求和兴趣的个人经历，态度和信仰。

 DESCRIPTION (provided by applicant): Project Background/Rationale: Tinnitus is common among Veterans, particularly those with a history of traumatic brain injury (TBI), and can result in substantial cognitive, emotional, or slep disorders. Over 1.1 million VA-enrolled Veterans were service-connected for tinnitus in 2013. Tinnitus is a life-long condition for which there is no "cure." However, our team has developed Progressive Tinnitus Management (PTM), a program designed to be delivered in-person or by telephone to teach Veterans (with and without TBI) methods for managing tinnitus symptoms. In randomized, controlled trials, clinic-based and telephone- based PTM led to clinically-significant reductions in tinnitus-related distress and dysfunction. Therefore, translation of evidence-based PTM into routine clinical practice is an imperative next-step. We are conducting research to understand barriers to PTM uptake across VA sites. Preliminary findings have shown that: 1) sites with comprehensive TBI services may be more prepared to implement PTM; but that, 2) all sites lack data supporting the need for, and interest in, PTM among Veterans with tinnitus. Project Aims: This project will address this gap by examining the epidemiology of clinically-significant tinnitus among Veterans in the VA system of care. Specifically, our aims are to: 1) Identify the proportion of Veterans with tinnitus in need of clinical services; 2) Examine Veterans' interests in PTM, either clinic- or telephone-based; and 3) Evaluate differences in Veterans' needs and interests by their TBI history. Project Methods: This two-year project will utilize a sequential mixed-methods study design. In Phase 1, we will conduct a survey of 1,200 randomly sampled Veterans identified with tinnitus and stratified by TBI history. Surveys will be mailed using a modified Dillman approach and will collect information on Veterans' tinnitus symptoms, severity, and dysfunction; interests in and perceptions of PTM; and overall health and functioning. In Phase 2, semi-structured telephone interviews will be conducted with a portion of survey respondents, purposively sampled based on response patterns to survey questions. Interviews will address Veterans' tinnitus symptoms and dysfunction; experiences with tinnitus-related healthcare; and interests in and perceived barriers to receiving PTM. Survey and interview data will be triangulated with VA administrative data to fully understand Veterans' needs for, and interests in, PTM services. Anticipated Impact: Tinnitus is an increasingly significant problem for Veterans, particularly those with a history of TBI. PTM is highly effective at reducing tinnitus-related dysfunction, but VA leaders and clinicians are in need of empirical data to support its implementation. Results of our research will directly address this need by generating contextualized (quantitative and qualitative) data on the number of Veterans in need of PTM services, their interests in receiving these services, and the personal experiences, attitudes, and beliefs that drive their expressed needs and interests.