Assessing Trends in STI Screening among Women Veterans in the VHA

评估 VHA 女性退伍军人性传播感染筛查的趋势

• 批准号: 10418470
• 负责人: Shimrit Keddem
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10418470
• 关键词: Advisory Committees; Affect; Age; Area; Awareness; Behavior; Benchmarking; Big Data; COVID-19; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Chlamydia; Chlamydia Infections; Clinic; Clinical Services; Counseling; Data; Data Analyses; Detection; Development; Diagnosis; Documentation; Early Diagnosis; Ectopic Pregnancy; Electronic Health Record; Eligibility Determination; Epidemiology; Evaluation; Exposure to; Feedback; Foundations; Future; General Population; Gonorrhea; Guidelines; HIV; HIV Infections; Health Promotion; Health Services Research; Health system; Healthcare; Hepatitis; Hysterectomy; Infection; Infertility; Informatics; Intervention; Interview; Investigator-Initiated Research; K-Series Research Career Programs; Lead; Methodology; Methods; Military Personnel; Outcome; Patient Self-Report; Patients; Pattern; Pelvic Inflammatory Disease; Personal Satisfaction; Play; Prevention; Preventive service; Primary Health Care; Provider; Recording of previous events; Reproductive Health; Research; Research Personnel; Research Proposals; Risk; Risk Factors; Role; Sexual Health; Sexually Transmitted Diseases; Site; Specific qualifier value; Symptoms; Testing; Time; Training; Unmarried; Veterans; Woman; Women' s Health; Women' s Health Services; Work; active duty; adverse outcome; base; career; career development; chronic pelvic pain; clinical decision support; cost effective; disorder prevention; effectiveness implementation trial; ethnic minority population; experience; high risk; improved; infection management; infection rate; innovation; intimate partner violence; male; men; military women; multilevel analysis; patient-level barriers; pilot test; post-traumatic stress; prevent; racial minority; research and development; response; routine screening; screening; screening guidelines; sexual trauma; sexual violence; sexually active; substance use; support tools; therapy design; tool; trend; uptake; usability; user centered design

Background: Rates of sexually transmitted infection (STI), especially gonorrhea and chlamydia, have increased dramatically over the past decade. Several factors put women Veterans at higher risk for STIs compared with both non-Veteran women and male Veterans, including substantial rates of exposure to sexual violence (including military sexual trauma), intimate partner violence, and unsafe behavior associated with posttraumatic stress and related substance use. Women are also more vulnerable to STI effects, as infection may be asymptomatic, undetected, and lead to complications. Guideline-recommended STI screening can detect infection and mitigate negative outcomes, but screening is underutilized. Significance/Impact: Women’s health and primary care are priority areas identified by VA/ORD, and the VA Directive 1330.01 states that facilities are required to provide STI screening and counseling in VA women’s health and primary care clinics. However, screening protocols across VA are not well-implemented and screening rates are suboptimal. To improve screening and outcomes, it is necessary to understand the current landscape of STI screening in VA. Innovation: The study is topically innovative because it focuses on a very prevalent but understudied issue that plays a critical role in women’s functioning and well-being. Few studies have examined the epidemiology of STIs in women Veterans and none has assessed health system responses to STIs or examined patterns in rates of STI screening among women Veterans across patient, provider or practice characteristics. Further, there is currently very little structural or informational support for providers screening for STIs. Specific Aims: Use administrative data to examine practice-, provider-, and patient-level correlates of gonorrhea and chlamydia screening in VA (Aim 1); use qualitative interviews to explore practice-, provider-, and patient-level barriers and facilitators to STI screening in VA women’s health and primary care clinics (Aim 2); and use principles of user-centered design to develop a multi-pronged clinical decision support tool to improve gonorrhea and chlamydia screening for women Veterans in women’s health and primary care and pilot test it at VA facilities to assess uptake, usability, and reach (Aim 3). Methodology: With a mixed-methods approach in Aims 1 & 2, employing quantitative electronic health record analyses and subsequent qualitative interviews, this proposed CDA will examine correlates of screening and explore barriers and facilitators to STI screening among women Veterans from both a patient and provider perspective. These findings will inform Aim 3, the development of a clinical decision support tool employing user-centered design, a participatory approach that incorporates multiple rounds of stakeholder feedback. The clinical decision support tool will alert providers to gonorrhea and chlamydia screening needs, support sexual history-taking and documentation, and raise awareness of screening guidelines to enhance STI management for women patients across VA. The final tool will be tested in a small feasibility pilot at two VISN 4 facilities to assess uptake, usability, and reach. Next Steps/ Implementation: Findings from this study will be augmented by an HSR&D investigator-initiated research (IIR) proposal in Year 3 to examine women Veteran’s use of non-VA care for GC/CT and inform an IIR proposal in Year 5 for an effectiveness-implementation trial to test the decision support tool at multiple VA sites.

背景：性传播感染（STI），特别是淋病和衣原体的发病率 过去十年中，有几个因素急剧增加，导致女性退伍军人感染性传播感染的风险更高。 与非退伍军人女性和男性退伍军人相比，包括大量的性接触率 暴力（包括军事性创伤）、亲密伴侣暴力以及与相关的不安全行为 创伤后应激和相关物质使用也更容易受到性传播感染（如感染）的影响。 可能无症状、未被发现并导致指南建议的性传播感染筛查。 检测感染并减轻负面结果，但筛查未得到充分利用。 意义/影响：妇女健康和初级保健是 VA/ORD 和 VA 确定的优先领域 指令 1330.01 规定，设施必须为 VA 妇女提供性传播感染筛查和咨询服务 然而，退伍军人管理局的筛查方案并未得到很好的实施和实施。 为了改善筛查和结果，有必要了解当前的情况。 弗吉尼亚州性传播感染筛查情况。 创新：该研究具有主题创新性，因为它关注的是一个非常普遍但尚未得到充分研究的问题 很少有研究对流行病学进行调查。 女性退伍军人中性传播感染的比例，但没有人评估卫生系统对性传播感染的反应或检查 女性退伍军人中不同患者、提供者或实践特征的性传播感染筛查率。 目前，对提供者筛查性传播感染的结构或信息支持非常少。 具体目标：使用管理数据来检查实践、提供者和患者层面的相关性 VA 的淋病和衣原体筛查（目标 1）；使用定性访谈来探索实践、提供者、 退伍军人事务部妇女健康和初级保健诊所中性传播感染筛查的患者层面障碍和促进因素（目标 2）；并利用以用户为中心的设计原则开发多管齐下的临床决策支持工具 改善妇女健康和初级保健领域的女性退伍军人的淋病和衣原体筛查以及试点 在 VA 设施中对其进行测试，以评估其吸收率、可用性和覆盖范围（目标 3）。 方法：在目标 1 和 2 中采用混合方法，采用定量电子健康记录 分析和随后的定性访谈，拟议的 CDA 将检查筛选和 探索并促进对来自患者和提供者的女性退伍军人进行性传播感染筛查 这些发现将为目标 3 提供信息，即开发临床决策支持工具。 以用户为中心的设计，一种包含多轮利益相关者反馈的参与式方法。 临床决策支持工具将提醒提供者淋病和衣原体筛查需求，支持性行为 病史采集和记录，并提高筛查意识，以加强性传播感染管理指南 最终工具将在两个 VISN 4 设施中进行小型可行性试点测试，以帮助整个 VA 的女性患者。 评估吸收率、可用性和覆盖范围。 后续步骤/实施：这项研究的结果将由 HSR&D 调查员发起的补充 第三年的研究 (IIR) 建议检查女性退伍军人使用非 VA 护理进行 GC/CT 的情况，并告知 IIR 在第 5 年提议进行有效性实施试验，以测试多个 VA 的决策支持工具 网站。