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

• 批准号: 8479331
• 负责人: Mary Jo Larson
• 金额: $ 40.88万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-15 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8479331
• 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; 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; screening; service utilization; statistics; stressor; surveillance data; treatment response; vigilance

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.

描述（由申请人提供）：本研究申请的总体目标是调查早期问题识别以及与行为保健的联系与后来药物滥用和心理伤害结果以及武装部队减员之间的关系。这项观察性研究基于准实验设计，采用纵向数据文件和部署相关因素和军事卫生服务的统计模型，研究长期不良药物滥用结果、不良心理结果（例如创伤后应激障碍、抑郁症）、有害行为的想法以及与参与持久自由行动（OEF）或伊拉克自由行动（OIF）相关的军队减员。 我们将组建一批陆军成员（现役和预备役人员），并于 2008-2010 财年结束部署。所有队列成员的结果将从 12 个月到 24 个月进行跟踪，早期队列进入者的结果将在 36 个月内进行跟踪。我们将比较 OEF/OIF 队列中接受早期治疗开始和参与的组与未接受早期治疗开始和参与的队列中的对照组（使用倾向评分对创伤暴露和自我报告问题进行加权）的结果。订婚。我们还将比较军事卫生系统 (MHS) 专业人员识别并尽早转介进行后续评估的 OEF/OIF 返回者群体的结果，该群体来自自我报告潜在问题的群体（使用倾向评分加权）没有及早识别和转介。 早期识别和转诊（返回后两个月内）的作用以及与治疗的早期联系（返回后 5 个月内）将是分析的主要焦点。我们将合并队列成员的 MHS 和退伍军人管理局 (VA) 数据，形成以前无法用于分析的完整纵向文件，并观察退伍军人在两个卫生系统中的延迟问题呈现和服务利用情况，以及长期的不良物质滥用和心理问题。陆军的结果和消耗。我们还能够描述并更好地了解哪些退伍军人在所有符合条件的人中向 VA 寻求护理，因为 VA 统计数据表明，35% 或更少的 OEF/OIF 正在使用他们有权享受的 VA 服务。研究结果将为 MHS 和 VA 中需要临床和政策关注的紧急问题的质量改进计划提供可操作的可操作数据。

项目成果

Suicides among military personnel.

军人自杀。

• DOI: 10.1001/jama.2013.282695
• 发表时间: 2013
• 期刊: JAMA
• 作者: Larson,MaryJo;Ritter,GrantA;Adams,RachelSayko
• 通讯作者: Adams,RachelSayko

Gender differences in substance use treatment utilization in the year prior to deployment in Army service members.

陆军服役人员部署前一年药物滥用治疗利用率的性别差异。

• DOI: 10.1016/j.jsat.2013.04.001
• 发表时间: 2013
• 期刊: Journal of substance abuse treatment
• 影响因子: 3.9
• 作者: Wooten,NikkiR;Mohr,BethA;Lundgren,LenaM;Adams,RachelSayko;Merrick,ElizabethL;Williams,ThomasV;Larson,MaryJo
• 通讯作者: Larson,MaryJo

Army Active Duty Members' Linkage to Veterans Health Administration Services After Deployments to Iraq or Afghanistan and Following Separation.

陆军现役军人在部署到伊拉克或阿富汗以及分离后与退伍军人健康管理服务的联系。

• DOI: 10.7205/milmed-d-14-00682
• 发表时间: 2015
• 期刊: Military medicine
• 影响因子: 1.2
• 作者: Vanneman,MeganE;Harris,AlexHS;Chen,Cheng;Mohr,BethA;Adams,RachelSayko;Williams,ThomasV;Larson,MaryJo
• 通讯作者: Larson,MaryJo

Postdeployment Behavioral Health Screens and Linkage to the Veterans Health Administration for Army Reserve Component Members.

陆军预备役成员部署后行为健康筛查以及与退伍军人健康管理局的联系。

• DOI: 10.1176/appi.ps.201600259
• 发表时间: 2017
• 期刊: Psychiatric services (Washington, D.C.)
• 作者: Vanneman,MeganE;Harris,AlexHS;Chen,Cheng;Adams,RachelSayko;Williams,ThomasV;Larson,MaryJo
• 通讯作者: Larson,MaryJo

Predictors of Positive Illicit Drug Tests After OEF/OIF Deployment Among Army Enlisted Service Members.

陆军入伍军人中 OEF/OIF 部署后非法药物检测呈阳性的预测因素。

• DOI: 10.7205/milmed-d-15-00110
• 发表时间: 2016
• 期刊: Military medicine
• 影响因子: 1.2
• 作者: Larson,MaryJo;Mohr,BethA;Jeffery,DianaD;Adams,RachelSayko;Williams,ThomasV
• 通讯作者: Williams,ThomasV