First Longitudinal Study of Missed Treatment Opportunities Using DOD and VA Data

使用 DOD 和 VA 数据对错过的治疗机会进行首次纵向研究

基本信息

批准号：
8263193
负责人：
Mary Jo Larson
金额：
$ 11.05万
依托单位：
BRANDEIS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-07-15 至 2014-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8263193
关键词：
Address Alcohol abuse Alcohol consumption Alcohol or Other Drugs use Attention Behavior Behavior Therapy Behavioral Caring Characteristics Clinical Cohort Studies Collaborations Communities Data Data Files Data Set Data Sources Development Diagnosis Diagnostic Disease Distress Early identification Early treatment Environment Event Exclusion Experimental Designs Family member Female Freedom Frequencies Goals Health Health Services Health system Healthcare Human Resources Individual Injury Intervention Interview Left Life Link Longitudinal Studies Measures Medical Medical Records Mental Depression Mental disorders Military Personnel Morbidity - disease rate Normalcy Observational Study Online Systems Outcome Overdose Patient Self-Report Pattern Performance Policies Post-Traumatic Stress Disorders Prevalence Problem behavior Procedures Process Process Measure Provider Publishing Recording of previous events Records Reporter Reporting Research Research Project Grants Resources Risk Risk Behaviors Risk Factors Role Sample Size Sampling Screening procedure Services Site Soldier Specialist Statistical Models Stress Subgroup Substance Use Disorder Substance abuse problem Surveillance Program Surveys Survival Analysis Symptoms Thinking Time Trauma Treatment Factor United States Department of Veterans Affairs Veterans War Weight adverse outcome arm base behavioral health care seeking clinical practice cohort combat comparison group direct application disability experience follow-up improved informant innovation intervention program member operation prescription opioid prevent programs psychologic psychological outcomes public health relevance response service utilization statistics stressor surveillance data treatment response vigilance

项目摘要

DESCRIPTION (provided by applicant): The overall aim of this research application is to investigate the relationship of early problem identification and linkage to behavioral health care with later development of substance abuse and psychological injury outcomes and attrition from the armed services. This observational study is based on a quasi-experimental design with longitudinal data files and statistical models of deployment-related factors and military health services on the odds of long-term poor substance abuse outcomes, poor psychological outcomes (e.g. post-traumatic stress disorder, depression), thoughts of harmful behavior, and attrition from the Army, associated with service in Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF). We will form a cohort of Army members (active-duty and Reserve component) with deployments ending in FY2008-2010. Outcomes will be tracked, starting at 12 months through 24 months, for all cohort members and 36 months for early cohort entrants. We will compare the outcomes of a group that receives early treatment initiation and engagement among the OEF/OIF cohort to a comparison group from the cohort (weighted for trauma exposure and self-report problems using propensity scores) that does not receive early treatment initiation and engagement. We also will compare the outcomes for the OEF/OIF returnee group that a military health system (MHS) professional identifies and refers early for follow-up assessment to a group from the cohort with self-report of potential problems (weighted using propensity scores) without early identification and referral. The role of this early identification and referral (within two months of return), and this early linkage to treatment (within 5 months of return) will be the primary focus of the analysis. We will merge MHS and Veterans Administration (VA) data for the cohort members to form complete longitudinal files previously unavailable for analyses, with observations of veterans' delayed problem presentation and service utilization in both health systems, and long-term adverse substance abuse and psychological outcomes and attrition from the Army. We also will be able to describe and better understand which combat veterans seek care from the VA among all that are eligible, as VA statistics suggest that 35% or fewer of OEF/OIF are using VA services to which they are entitled. The findings will provide operationally actionable data useful to quality improvement programs in the MHS and VA on urgent issues requiring clinical and policy attention. PUBLIC HEALTH RELEVANCE: This application will provide operationally actionable data useful to quality improvement programs in the military health system (MHS) and Veterans Administration (VA) on urgent issues requiring clinical and policy attention. We will investigate the substance abuse and psychological outcomes of receiving early identification and linkage to behavioral health care in a cohort of Army members returning from OEF/OIF, merging MHS and VA data to create a previously unavailable data files.

描述（由申请人提供）：本研究申请的总体目的是调查早期问题识别与行为医疗保健与后期滥用药物滥用和心理伤害成果的发展以及武装服务流失的关系。这项观察性研究基于一种准实验设计，其纵向数据文件以及与部署相关因素和军事保健服务的统计模型以及长期不良药物滥用结果的几率，不良的心理压力结果（例如，创伤后应激障碍，抑郁症），抑郁症），危害行为的思想，对军队的思想以及在运营自由（ORA）的自由度（OOF）或IRA（OOIF）与IRA相关（OOIF）。我们将组建一组陆军成员（现役和预备役部分），其部署于2010财年结束。所有队列成员的成果将在12个月至24个月的时间内进行跟踪，而早期队列参赛者的成果将为36个月。我们将比较一个小组的结局，该组的结果是在OEF/OIF队列中接受早期治疗启动和参与度与该队列的比较组（以创伤暴露和使用倾向分数的自我报告问题）无法接受早期治疗开始和参与。我们还将比较OEF/OIF返回组的结果，即军事卫生系统（MHS）专业人士确定并提早将后续评估与来自同类小组的后续评估有关，该小组与潜在问题的自我报告（使用倾向得分加权）没有早期识别和转介。这种早期识别和推荐的作用（在返回后的两个月内）以及与治疗的这种早期联系（在返回后的5个月内）将是分析的主要重点。我们将合并MHS和退伍军人管理（VA）数据，以使队列成员形成以前无法进行分析的完整纵向文件，并观察退伍军人在卫生系统中的延迟问题表现和服务利用，以及长期不良药物滥用，滥用和心理的侵害，以及陆军的侵犯。我们还将能够描述并更好地理解哪些战斗退伍军人在所有符合条件的情况下从VA寻求护理，因为VA统计数据表明，OEF/OIF的35％或更少正在使用其应有的VA服务。这些发现将为需要临床和政策关注的紧急问题提供对MHS和VA中质量改进计划有用的操作可行数据。公共卫生相关性：该应用程序将提供对需要临床和政策关注的紧急问题的军事卫生系统（MHS）（MHS）（MHS）（MHS）（MHS）（MHS）（MHS）中有用的数据。我们将调查在从OEF/OIF返回的一群陆军成员中，接收早期识别和与行为医疗保健的毒品滥用和心理成果，并将MHS和VA数据合并以创建以前无法使用的数据文件。