Addressing Social Determinants of Health Among Rural Veterans

解决农村退伍军人健康的社会决定因素

• 批准号: 10308137
• 负责人: Deborah Gurewich
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10308137
• 关键词: Accounting; Address; COVID-19; Cardiovascular Diseases; Caring; Characteristics; Clinical; Collaborations; Communities; Data; Development; Disease; Economic Conditions; Economics; Effectiveness; Epidemiology; Evaluation; Feedback; Future; Goals; Health; Health Policy; Health Services Research; Healthcare; Homelessness; Human Resources; Individual; Infrastructure; Intervention; Interview; Knowledge; Lead; Logistics; Medical center; Methodology; Methods; Mission; Modeling; New England; Outcome; Patients; Phase; Plant Roots; Policy Maker; Population; Positioning Attribute; Prevalence; Process; Provider; Randomized Controlled Trials; Replicating Effective Programs; Research; Resources; Risk; Rural; Rural Community; Rural Health; Scientific Advances and Accomplishments; Service setting; Services; Site; Social Conditions; Social Network; Social Work; Suicide; Surveys; System; Time; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; Work; base; care outcomes; comorbidity; economic need; effectiveness implementation study; effectiveness study; evidence base; experience; food insecurity; health equity; implementation barriers; improved; innovation; novel; pilot test; preference; research and development; routine screening; rural America; rural setting; screening; social; social adversity; social health determinants; urban area; urban setting; user centered design

Background: Rural Veterans represent over one third of all Veterans served by the Department of Veterans Affairs and rural America is strikingly different than urban areas with respect to the social and economic conditions that drive health. Based on research documenting the relationship between social adversity (e.g., homelessness, food insecurity) and health, policy makers suggest routine screening and referral (S&R) for unmet social and economic needs (hereafter: “unmet needs”) in the clinical setting. This call has catalyzed a small but promising evidence base, indicating that efficacy of S&R. However, the S&R evidence base focuses on unmet needs in urban settings. This means we lack the knowledge needed to adapt unmet need S&R for the unique needs of rural VA settings and the rural Veterans they serve. Significance: Our study addresses the HSR&D priorities to mitigate the unmet needs of Veterans and to integrate heath care solutions as much as possible into existing care, rather than depending on new personnel and resources. This study will advance these priorities by adapting the specifications of evidence-based S&R to align with existing unmet needs and unmet need resources in rural VA settings. This study will also establish a process for adapting S&R that can be replicated across VISNs and facilities. Innovation and Impact: This research is highly innovative as we know of no research that is implementing unmet need interventions for rural Veterans. We will provide novel knowledge about unmet needs among rural Veterans, the mechanism by which these needs manifest, and the social service infrastructure within the VA and community that serve rural Veterans. Our research is also innovative in our use of user-centered design (UCD) methods to adapt the specifications of an S&R intervention. Specifically, throughout the process of adapting S&R to the target local sites, we will engage and solicit feedback from the eventual end-users, including Veterans. Specific Aims: 1) Determine unmet needs among rural Veterans and their associations with health outcomes; 2) Assess existing systems for addressing unmet needs and adapt S&R to fit local conditions and stakeholder preferences; 3) Pilot test the adapted intervention and develop an Adaptation Playbook. Methodology: Guided by the Replicating Effective Programs (REP) framework, we propose a 3-year mixed- methods study. We will survey rural Veterans served by VISN 1 about their unmet needs and merge survey data with secondary VA data to assess the scope and scale of unmet needs and their associations with health care outcomes. We will conduct qualitative interviews with key stakeholders (Veterans, VA providers and staff, representatives of community agencies) to understand how unmet needs manifest among rural Veterans, the existing infrastructure for identifying unmet needs and referring for services, and opportunities and preferences for adapting S&R. We will use the information gathered from these interviews and UCD methods to adapt the specifications of S&R. Finally, we will pilot the adapted S&R intervention, refine as needed, and develop an Adaptation Playbook detailing how other facilities can adapt S&R to their local conditions. Next Steps/Implementation: Upon completion of the IIR, we will have moved through the first two of four REP phases (pre-conditions and pre-implementation). By doing so, we will understand the key components necessary for REP phases three and four, which will be the focus of future work (full-scale implementation of the adapted S&R intervention and evaluation) in on-going collaboration with our operational partners the New England Veterans Integrated Service Network, Office of Rural Health and Office of Social Work.

背景：农村退伍军人代表退伍军人服务的所有退伍军人的三分之一 在社会和经济方面，事务和粗糙的美国与城市地区的不同 促进健康的条件。基于研究文档，社会广告之间的关系（例如 无家可归，粮食不安全）和健康，政策制定者建议例行筛查和推荐（S＆R） 在临床环境中未满足的社会和经济需求（以下：“未满足需求”）。这个电话催化了 小但有望证据基础，表明标准普尔的有效性。但是，S＆R证据基础重点 关于城市环境中未满足的需求。这意味着我们缺乏适应未满足需求S＆R的知识 弗吉尼亚州农村环境和他们所服务的农村退伍军人的独特需求。 意义：我们的研究针对HSR＆d的优先级，以减轻退伍军人的未满足需求和 尽可能多地集成了荒地护理解决方案，而不是根据新人员 和资源。这项研究将通过调整基于证据的S＆R的规格来提高这些优先级 在粗糙的VA设置中与现有的未满足需求和未满足需要的资源保持一致。这项研究也将建立 适应S＆R的过程，可以在VISN和设施中复制。 创新和影响：这项研究具有很高的创新性，因为我们知道没有实施的研究 未满足农村退伍军人的干预措施。我们将提供有关农村未满足需求的新知识 退伍军人，这些需求表现出的机制以及VA中的社会服务基础设施 和为农村退伍军人服务的社区。我们的研究在使用以用户为中心的设计方面也是创新的 （UCD）调整S＆R干预规范的方法。具体而言，在整个过程中 将S＆R适应目标本地站点，我们将参与并征求活动最终用户的反馈， 包括退伍军人。 具体目的：1）确定农村退伍军人的需求及其与健康结果的联系； 2）评估现有系统，以满足未满足的需求并调整S＆R以适合当地条件和利益相关者 偏好； 3）试点测试适应的干预措施并制定适应性剧本。 方法论：在复制有效计划（REP）框架的指导下，我们提出了为期3年的混合 方法研究。我们将调查Visn 1为他们未满足的需求和合并调查的粗略退伍军人 具有次要VA数据的数据，以评估未满足需求的范围和规模及其与健康的关联 护理结果。我们将对主要利益相关者（退伍军人，VA提供者和员工， 社区机构的代表）了解农村退伍军人之间未满足的需求如何 现有的基础架构，以识别未满足的需求和参考服务以及机会和偏好 用于改编S＆R。我们将使用这些访谈和UCD方法收集的信息来适应 S＆R的规格。最后，我们将试用改编的S＆R干预，根据需要进行完善，并开发 适应性剧本详细介绍了其他设施如何适应其当地条件。 下一步/实施：IIR完成后，我们将通过四个代表中的前两个转移 阶段（条件和实施前）。通过这样做，我们将了解关键组件 重复第三和第四阶段所必需的，这将是未来工作的重点（全面实施 改编的S＆R干预和评估）与我们的运营合作伙伴进行了持续的合作 英格兰退伍军人综合服务网络，农村健康办公室和社会工作办公室。