A Structured Communication Tool to Improve OEF/OIF Veteran Care

改善 OEF/OIF 退伍军人护理的结构化沟通工具

• 批准号: 8442741
• 负责人: RICHARD Warren GOLDBERG
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8442741
• 关键词: Address; Afghanistan; Anxiety; Appointment; Caring; Client satisfaction; Cognitive Therapy; Communication; Communication Tools; Computers; Conflict (Psychology); Data; Development; Ensure; Failure; Focus Groups; Fostering; Freedom; Goals; Health; Health Personnel; Homelessness; Individual; Interview; Iraq; Lead; Life; Manuals; Mediating; Medical; Mental Depression; Mental Health; Mental Health Services; Methods; Modification; Monitor; Outcome; Patient-Centered Care; Patients; Post-Traumatic Stress Disorders; Procedures; Provider; Psyche structure; Quality of life; Randomized; Recovery; Reporting; Research; Services; Specific qualifier value; Staging; Structure; Substance abuse problem; Suicide; Symptoms; Technology; Testing; Treatment outcome; United Kingdom; United States; Veterans; Violence; base; care systems; computerized; computerized tools; design; follow-up; health care delivery; improved; indexing; innovation; meetings; member; operation; patient oriented; pilot trial; satisfaction; severe mental illness; social; standard care; tool; treatment adherence

DESCRIPTION (provided by applicant): Background: Over 1.6 million US service members have served in Afghanistan or Iraq as part of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), and up to 15% of them report significant mental health symptoms. Failure to engage in treatment remains a significant obstacle and one that can lead to devastating consequences including exacerbation of psychiatric symptoms, deteriorating social and vocational functioning, homelessness, substance abuse, and suicide (2,3,6-8). Because disengagement from mental health treatment may reflect the OEF/OIF veteran's perspective that treatment is not meeting his/her needs or not being provided in a collaborative manner, there is a growing imperative to develop and implement veteran- centered strategies for fostering treatment engagement with the longer-term goal of improving treatment outcomes for newly returning veterans. This imperative is reflected in the mandates specified in the so-called VA Action Agenda (9) to create a system of care that is recovery-oriented and patient centered. Despite the mounting evidence suggesting that computer-mediated technologies designed to help structure and enhance patient-clinician communication can lead to improved patient health and functioning across a variety of medical conditions (10), their implementation in mental health service delivery has occurred only recently. Providing mental health clinicians with a tool to ensure delivery of mandated patient-centered care and affording veterans an opportunity to more meaningfully participate in the identification of treatment priorities will have significant impact on improving treatment engagement and related outcomes for OEF/OIF veterans. Aims: The specific aims for this proposed two year pilot are to: 1) Modify an existing computerized structured communication tool called DIALOG to reflect the mental health treatment needs of OEF/OIF veterans and enhance implementation procedures based on principles and strategies of Cognitive Behavioral Therapy (CBT); and 2) Complete a randomized pilot for 32 OEF/OIF veterans and their mental providers to generate preliminary data supporting our hypotheses that use of the modified and enhanced DIALOG tool will: a) improve mental health treatment engagement as defined by increased likelihood of attending a subsequent mental health appointment following index use of the tool; and b) result in a decrease in veteran reported unmet needs, more positive ratings of treatment satisfaction, and improved ratings of quality of life. Methods: Our proposal includes a two-stage effort that parallels our Specific Aims. Stage One will be completed during year one and will focus on modifying and enhancing the DIALOG tool. In addition to convening multiple meetings with an advisory group of experts and OEF/OIF veterans, we will also beta-test modifications and complete interviews and focus groups with veteran and mental health provider users of the tool to evaluate acceptability and feasibility. Stage Two, completed during the second year, will involve a carefully monitored randomized pilot. OEF/OIF veterans will be randomized to either the experimental condition (defined by use of the DIALOG structured communication tool) or the control condition (defined by delivery of standard treatment without use of the DIALOG tool). Using a pre-post design over a 3-month period, outcomes assessed will include: rates of attending a subsequent mental health appointment following index use of the DIALOG tool, and veteran ratings of unmet needs, treatment satisfaction and quality of life. Impact: The development of the proposed computerized structured communication tool and innovative implementation enhancements drawing on the principles and strategies of CBT will contribute to the VA mandate to deliver patient-centered services to OEF/OIF veterans to better meet their pressing treatment needs. Providing clinicians with a simple tool to consistently and effectively delivery patient-centered mental health services could have significant impact on improving treatment engagement and related outcomes for OEF/OIF veterans.

描述（由申请人提供）： 背景：超过 160 万美国军人曾作为持久自由行动 (OEF) 和伊拉克自由行动 (OIF) 的一部分在阿富汗或伊拉克服役，其中高达 15% 的军人报告有明显的心理健康症状。未能接受治疗仍然是一个重大障碍，可能导致毁灭性后果，包括精神症状恶化、社会和职业功能恶化、无家可归、药物滥用和自杀 (2,3,6-8)。由于脱离心理健康治疗可能反映了 OEF/OIF 退伍军人的观点，即治疗未满足他/她的需求或未以协作方式提供，因此越来越有必要制定和实施以退伍军人为中心的策略，以促进治疗参与改善新返回退伍军人治疗效果的长期目标。这一当务之急反映在所谓的退伍军人管理局行动议程 (9) 中指定的任务中，以创建一个以康复为导向、以患者为中心的护理系统。尽管越来越多的证据表明，旨在帮助构建和加强患者与临床医生沟通的计算机介导技术可以改善患者的健康和各种医疗状况的功能 (10)，但它们在心理健康服务提供中的实施直到最近才发生。为心理健康临床医生提供一个工具，确保提供以患者为中心的强制护理，并为退伍军人提供更有意义地参与确定治疗优先事项的机会，将对提高 OEF/OIF 退伍军人的治疗参与度和相关结果产生重大影响。目标：拟议的为期两年的试点的具体目标是： 1) 修改现有的计算机化结构化沟通工具 DIALOG，以反映 OEF/OIF 退伍军人的心理健康治疗需求，并根据认知行为治疗的原则和策略加强实施程序（认知行为治疗）； 2) 完成对 32 名 OEF/OIF 退伍军人及其心理服务提供者的随机试点，以生成支持我们假设的初步数据，即使用修改和增强的 DIALOG 工具将： a) 提高心理健康治疗参与度，定义为增加参加心理健康治疗的可能性使用该工具后进行后续心理健康预约； b) 减少退伍军人报告的未满足的需求，对治疗满意度的评价更加积极，并提高生活质量的评价。方法：我们的建议包括与我们的具体目标相一致的两阶段工作。第一阶段将在第一年完成，重点是修改和增强 DIALOG 工具。除了与专家咨询小组和 OEF/OIF 退伍军人召开多次会议外，我们还将对修改进行 Beta 测试，并与该工具的退伍军人和心理健康提供者用户完成访谈和焦点小组，以评估可接受性和可行性。第二阶段在第二年完成，将涉及仔细监控的随机试点。 OEF/OIF 退伍军人将被随机分配到实验条件（通过使用 DIALOG 结构化通信工具定义）或控制条件（通过在不使用 DIALOG 工具的情况下提供标准治疗定义）。使用为期 3 个月的前后设计，评估的结果将包括：使用 DIALOG 工具索引后参加后续心理健康预约的比率，以及退伍军人对未满足需求、治疗满意度和生活质量的评级。影响：拟议的计算机化结构化通信工具的开发以及基于 CBT 原则和策略的创新实施增强功能将有助于 VA 的使命，即向 OEF/OIF 退伍军人提供以患者为中心的服务，以更好地满足他们紧迫的治疗需求。为临床医生提供一个简单的工具来持续有效地提供以患者为中心的心理健康服务，可能会对提高 OEF/OIF 退伍军人的治疗参与度和相关结果产生重大影响。