Serving All Who Have Served: Enhancing Suicide-Related Care Quality for Black, Indigenous, and People of Color Veterans

为所有服役人员提供服务：提高黑人、原住民和有色人种退伍军人与自杀相关的护理质量

• 批准号: 10640795
• 负责人: Jason I Chen
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10640795
• 关键词: Address; Adherence; Affect; Age; Area; Belief; Black, Indigenous, People of Color; Caring; Characteristics; Clinical; Cognitive; Data; Data Sources; Databases; Diagnosis; Discrimination; Ensure; Equation; Equity; Evaluation; Frequencies; Future; Gender; Gender Identity; General Population; Guidelines; Health; Healthcare Systems; Hospitalization; Inpatients; Intervention; Interview; Light; Link; Literature; Logistics; Measures; Medical Records; Mental Health; Mental Health Services; Methodology; Methods; Modeling; Outcome; Outpatients; Patients; Population Characteristics; Post-Traumatic Stress Disorders; Process; Provider; Quality Indicator; Quality of Care; Race; Recommendation; Recording of previous events; Recovery; Research; Risk; Risk Factors; Safety; Sampling; Self Direction; Strategic Planning; Suicide; Suicide prevention; System; Veterans; Veterans Health Administration; Violence; Visit; burnout; comorbidity; data repository; data warehouse; demographics; design; enhanced care; ethnic difference; ethnic diversity; ethnic identity; experience; gender difference; health care quality; health disparity; health equity; high risk; improved; innovation; mortality; patient population; people of color; prevent; prevention service; provider factors; racial difference; racial identity; social; sociodemographics; suicidal morbidity; suicidal risk; suicide rate; therapy development

Background: Veteran suicide prevention remains the top clinical priority for the Veterans Health Administration (VHA). To mitigate Veteran suicide risk, VHA has national guidelines recommending an enhanced care package after self-directed violence (SDV) such as creating a suicide safety plan or increasing the frequency of outpatient mental health visits. Adherence to each given care component is considered a marker of care quality for suicide risk (henceforth referred to as suicide-related care quality). Recent research utilizing national VHA data suggests these care components may not be provided equitably to all Veterans. As research shows that Black, Indigenous, and People of Color (BIPOC) Veterans experience poorer mental health care quality than white Veterans, it is possible that similar issues may impact their suicide-related care quality. However, no research to date has examined the quality of suicide-related care among BIPOC Veterans. Thus, further evaluation of suicide-related care quality is needed to ensure equitable, effective care for BIPOC Veterans with SDV. The current proposal seeks to evaluate components of suicide-related care quality among BIPOC Veterans using a concurrent, mixed-methods triangulation approach to inform future intervention development. Significance: The proposed project directly addresses VHA’s top clinical priority, suicide prevention. In addition, this proposal aligns with VA HSR&D’s high priority foci of suicide prevention and health equity as well as VHA National Strategic Plan Objectives 2.1 and 2.3 which focus on ensuring Veterans receive equitable, comprehensive suicide prevention services to support their recovery. VHA Office of Health Equity and VHA Office of Mental Health and Suicide Prevention also highlight in their strategic plans the need for supporting equitable, suicide-related care for all Veterans. Innovation and Impact: The proposed project is the first evaluation of suicide-related care quality among BIPOC Veterans with SDV. In addition, no research to date has determined areas to improve suicide-related care quality for BIPOC Veterans. Use of national VHA- and non-VHA administrative data triangulated with BIPOC Veteran and mental health clinician qualitative data will result in a richer conceptualization of current factors impacting suicide-related care and inform future strategies for enhancing care. Specific Aims: Aim 1) Evaluate suicide-related care quality among BIPOC Veterans; Aim 2) Conduct qualitative interviews with BIPOC Veterans and VA clinicians to better understand factors impacting suicide-related care quality for BIPOC Veterans; Aim 3) Explore associations between health care systems-level factors and suicide- related care quality indicators for BIPOC Veterans; Exploratory Aim) Explore the relationship between suicide- related care quality among BIPOC Veterans and suicide outcomes. Methodology: Aim 1 will identify BIPOC Veterans with SDV (FY18-FY22) utilizing VHA databases. Data from the VHA Corporate Data Warehouse for suicide-related care quality outcomes as well as sociodemographic and clinical variables will be linked. Data will be analyzed using generalized estimating equations. Aim 2 will involve interviews with at least 40 BIPOC Veterans and at least 40 VHA mental health clinicians about their beliefs and experiences with suicide-related care which will be analyzed using thematic analysis. Aim 3 will link data from Aim 1 to health care systems factors at the station level. For the Exploratory Aim will link data from mortality data sources to explore associations with mortality outcomes. Next Steps/ Implementation: The proposed project will increase our understanding of factors impacting suicide- related care quality among BIPOC Veterans. Findings from this project will inform future proposals focused on intervention development to enhance suicide-related care quality among BIPOC Veterans.

背景：预防退伍军人自杀仍然是退伍军人卫生管理局的最高临床性 （VHA）。 在自我指导的暴力（SDV）之后，例如制定自杀安全计划或增加门诊的频率 心理健康访问。 风险（风险（Henshiforth称为自杀相关的护理质量）。 这些护理组成部分可能不公平地向所有退伍军人提供。 土著人，有色人种（BIPOC）退伍军人经历的心理保健质量比白色差 退伍军人，象征性是他们自杀相关的护理质量的影响。 日期检查了Bipoc退伍军人中与自杀相关的护理质量。 需要与SDV的Bipoc退伍军人确保自杀相关的护理质量 当前的建议旨在评估BIPOC退伍军人中自杀相关护理质量的组成部分 并发，混合方法三角剖分，以告知未来的干预开发。 意义：支撑项目直接解决了VHA的最高临床预防预防自杀。 此外，该提案与VA VA HSR＆D的高优先级相一致。 作为VHA国家战略计划目标2.1和2.3，重点是确保退伍军人获得公平， 全面的自杀预防服务以支持其康复。 心理健康和预防自杀办公室也在其战略计划中强调了支持 所有退伍军人的公平，自杀式护理。 创新和影响：支撑项目是对BIPOC自杀相关护理质量的首次评估 SDV的退伍军人。此外，迄今为止尚无研究 用于BIPOC退伍军人。 心理健康临床医生定性数据将导致影响影响因素影响因素的影响因素的影响因素的影响。 自杀相关的护理，并为增强护理的未来策略提供信息。 特定目的：目标1）评估BIPOC退伍军人的自杀质量； 与BIPOC退伍军人和VA临床医生的访谈，以更好地了解影响自杀有关的护理的因素 BIPOC退伍军人的质量； AIM 3）探索医疗保健系统级别和自杀之间的关联 BIPOC退伍军人的相关护理质量指标； Bipoc退伍军人和自杀成果之间的相关护理质量。 方法：AIM 1将使用VHA数据库来识别具有SDV（FY18-FY22）的BIPOC退伍军人 VHA公司数据仓库，用于自杀相关的护理质量结果以及社会杂志和 临床变量将通过生成的估计方程进行分析。 与至少40名BIPOC退伍军人和至少40位VHA心理健康临床医生的访谈有关他们的信念和 具有自杀相关护理的经验，将使用主题分析进行分析。 目的1与探索目的的卫生保健系统因素。 来源探索与死亡率结果的关联。 下一步/实施：支撑项目将增加我们对影响自杀的影响因素的理解 - BIPOC退伍军人之间的相关护理将为未来的建议提供信息 间隔开发以提高BIPOC退伍军人的自杀相关护理质量。