Veterans' Care Access and Preferences for PTSD Treatment in the Community (VCAPP)

退伍军人的社区护理获取和 PTSD 治疗偏好 (VCAPP)

• 批准号: 8597213
• 负责人: Erin P Finley
• 金额: --
• 依托单位: SOUTH TEXAS VETERANS HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8597213
• 关键词: Address; Affect; Afghanistan; Caring; Case Study; Characteristics; Communities; Complex; Data; Diagnosis; Disease; Environment; Evidence based practice; Freedom; Geographic Factor; Geographic Information Systems; Geographic Locations; Health Care Reform; Health Services Accessibility; Healthcare; Housing; Improve Access; Individual; Investigator-Initiated Research; Iraq; Leadership; Life; Mental Health; Mental Health Services; Methods; Military Personnel; Modeling; Patient Self-Report; Patient-Centered Care; Patients; Pattern; Patterns of Care; Pilot Projects; Population; Post-Traumatic Stress Disorders; Provider; Quality of Care; Quality of life; Reporting; Research; Research Proposals; Resources; Sampling; Services; Surveys; Symptoms; Texas; Training Support; Veterans; base; behavioral health; care preference; care seeking; community based care; community setting; demographics; density; evidence base; improved; operation; predictive modeling; preference; response; skills; symposium

DESCRIPTION (provided by applicant): BACKGROUND: Post-traumatic stress disorder (PTSD) is thought to affect nearly one-fifth of Veterans of Operations Enduring Freedom (OEF; Afghanistan), Iraqi Freedom (OIF; Iraq), and New Dawn (OND; Iraq). Recognizing that evidence-based practices (EBPs) for PTSD can result in significant symptom reduction and improved quality of life for Veterans with the disorder, the Department of Veterans Affairs (VA) has invested in making EBPs for PTSD available at every VA facility nationwide. Such efforts to improve access to EBPs for PTSD have been stymied, however, by the fact that many recent Veterans elect to seek care in community settings rather than with VA. The proposed pilot research will inform VA efforts to improve access to high- quality, patient-centered care by comparing PTSD care utilization patterns among OEF/OIF/OND Veterans with PTSD living in Texas and identifying individual- and community-level factors associated with choice of VA or non-VA care setting. As Texas has the nation's second largest population of Veterans, with widely varying demographics and access to VA and other services, it provides an excellent case study for examining care- seeking, access to care, and care preferences among recent Veterans. METHODS: Our multi-disciplinary team will utilize a crosswalk of administrative data from the OEF/OIF/OND Roster and VETSNET to identify OEF/OIF/OND Veterans living in Texas who are service-connected for PTSD. We will then survey a stratified random sample of 1200 Veterans (estimated total n=400) to compare self-reported utilization of VA, military, and community-based care services, related patient-level factors as described in the model of Veterans' healthcare access developed at the most recent State of the Art (SOTA) Conference on Improving Access to VA Care (Fortney et al. 2011), and care preferences. We will also integrate patient-level information with Geographic Information Systems (GIS) data to examine whether geographic and community factors impact Veterans' PTSD care-seeking. With these methods, we will achieve the following aims: Objective 1. Compare demographic characteristics of OEF/OIF/OND Veterans with PTSD in Texas who report different patterns of PTSD care utilization: a) VA USERS who have only sought care for PTSD in VA settings since receiving their diagnosis; b) NON-VA USERS who have only sought PTSD care in non-VA settings, including military and/or community-based facilities, since diagnosis; c) DUAL USERS who have used both VA and non-VA PTSD care services since diagnosis; and d) NON-USERS who report no use of PTSD care services since diagnosis. Objective 2. Compare PTSD care preferences, perceived access and perceived need for care among individuals with different patterns of PTSD care utilization. Objective 3. Identify geographic factors such as proximity and density of PTSD care services associated with different patterns of PTSD care utilization. Dissemination and Next Steps: Pilot study findings will be used to inform an Investigator Initiated Research (IIR) proposal to develop and validate in a national sample a predictive model for understanding Veterans' PTSD care utilization in both VA and non-VA settings. This predictive model will support improved access to evidence-based PTSD care for Veterans by providing information to aid state and local and national VA mental health leadership in identifying targeted multi-level strategies for increasing Veterans' PTSD care access and engagement. Pilot study findings will have immediate operational relevance and will be disseminated to VA, state, and national partners.

描述（由申请人提供）： 背景：创伤后应激障碍（PTSD）被认为会影响持久自由的经营退伍军人（OEF；阿富汗），伊拉克自由（OIF;伊拉克）和新黎明（OND; ond; ond;伊拉克）。认识到，对PTSD的基于证据的实践（EBP）可能会导致该疾病的退伍军人症状大幅减轻和改善的生活质量，因此退伍军人事务部（VA）投资了在全国范围内每个VA设施可用的PTSD为PTSD提供EBP。然而，由于许多最近的退伍军人选择在社区环境而不是VA寻求护理的事实，因此为改善PTSD获得EBP的努力受到了阻碍。拟议的试点研究将通过比较OEF/OIF/OIF/OND退伍军人之间的PTSD护理利用模式，为VA提供了努力，以改善获得高质量的，以患者为中心的护理，而PTSD居住在得克萨斯州，并确定与选择VA或非VA护理环境相关的个人和社区级别的因素。由于得克萨斯州拥有美国第二大的退伍军人人口，并拥有广泛不同的人口统计学和获得VA和其他服务的机会，因此它提供了一个出色的案例研究，用于检查最近退伍军人的护理，获得护理和护理偏好。方法：我们的多学科团队将利用来自OEF/OIF/OND名册和VETSNET的人行横道数据，以识别居住在德克萨斯州的OEF/OIF/OIF/OND退伍军人，这些退伍军人居住在德克萨斯州，他们与PTSD连接。然后，我们将调查1200名退伍军人的分层随机样本（估计总n = 400），以比较自我报告的VA，军事和基于社区的护理服务，相关的患者级别 在最新的最新艺术状态（SOTA）会议上，有关改善VA护理访问权的最新情况（Fortney等人，2011年）和护理偏好开发的因素。我们还将将患者级信息与地理信息系统（GIS）数据整合在一起，以检查地理和社区因素是否影响退伍军人的PTSD护理寻求。通过这些方法，我们将实现以下目的：目标1。将OEF/OIF/OND退伍军人的人口统计学特征与德克萨斯州的PTSD进行比较，他们报告了P​​TSD护理利用率的不同模式：a）自从接受VA设置以来，他们仅寻求VA的VA用户，以自接受诊断。 b）自诊断以来，仅在非VA设置（包括军事和/或社区设施）中寻求PTSD护理的非VA使用者； c）自诊断以来使用VA和非VA PTSD护理服务的双重用户； D）自诊断以来不使用PTSD护理服务的非用户。目标2。比较具有不同模式的PTSD护理利用方式的PTSD护理偏好，感知到的访问和对护理的需求。目标3。确定地理因素，例如与PTSD护理使用不同模式相关的PTSD护理服务的接近度和密度。传播和下一步：试点研究结果将用于告知调查人员的启动研究（IIR）提案，以开发和验证 国家样本是了解VA和非VA设置中退伍军人的PTSD护理利用率的预测模型。这种预测模型将通过提供信息来帮助州以及地方和国家弗吉尼亚州心理健康领导力，以确定有针对性的多层策略，以提高退伍军人的PTSD护理访问和参与度，以帮助改善对退伍军人的PTSD护理。试点研究结果将立即具有运营相关性，并将传播到VA，州和国家合作伙伴。