Quantifying the Burden of Disease and Healthcare Need in Veterans and Civilians

量化退伍军人和平民的疾病负担和医疗保健需求

• 批准号: 10845255
• 负责人: Katherine JoAnn Hoggatt
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10845255
• 关键词: 20 year old; Acceleration; Achievement; Affordable Care Act; Age; Behavioral Risk Factor Surveillance System; Caring; Clinic; Communities; Community Health; Community Healthcare; Comprehensive Health Care; Consensus; Data; Drug usage; Elderly man; Ensure; Ethnic Origin; Evaluation; Foundations; Funding; Gender; General Population; Geographic Locations; Goals; Health; Health Services Accessibility; Health Status; Health behavior; Healthcare; Healthcare Systems; Impairment; Injury; Integrated Health Care Systems; Knowledge; Learning; Marketing; Measures; Medical; Medicare; Mental Health; Methodology; Methods; Modernization; National Health Interview Survey; Outcome; Outcome Study; Outpatients; Patients; Pattern; Policies; Policy Maker; Population; Population Characteristics; Population Distributions; Prevalence; Preventive care; Private Sector; Privatization; Probability; Process; Provider; Public Sector; Race; Readiness; Reporting; Research; Resources; Risk; Risk Factors; Services; Source; Subgroup; Surveys; System; Time; Update; Veterans; Veterans Health Administration; Vision; Visual; War; Work; burden of illness; care outcomes; comorbidity; comparative; data warehouse; demographics; design; evidence based guidelines; health care availability; health care service; health care service utilization; health difference; health equity; health plan; health related quality of life; improved; innovation; integrated care; neglect; physical conditioning; programs; provider networks; routine practice; secondary analysis; sociodemographics; 20 year old; Acceleration; Achievement; Affordable Care Act; Age; Behavioral Risk Factor Surveillance System; Caring; Clinic; Communities; Community Health; Community Healthcare; Comprehensive Health Care; Consensus; Data; Drug usage; Elderly man; Ensure; Ethnic Origin; Evaluation; Foundations; Funding; Gender; General Population; Geographic Locations; Goals; Health; Health Services Accessibility; Health Status; Health behavior; Healthcare; Healthcare Systems; Impairment; Injury; Integrated Health Care Systems; Knowledge; Learning; Marketing; Measures; Medical; Medicare; Mental Health; Methodology; Methods; Modernization; National Health Interview Survey; Outcome; Outcome Study; Outpatients; Patients; Pattern; Policies; Policy Maker; Population; Population Characteristics; Population Distributions; Prevalence; Preventive care; Private Sector; Privatization; Probability; Process; Provider; Public Sector; Race; Readiness; Reporting; Research; Resources; Risk; Risk Factors; Services; Source; Subgroup; Surveys; System; Time; Update; Veterans; Veterans Health Administration; Vision; Visual; War; Work; burden of illness; care outcomes; comorbidity; comparative; data warehouse; demographics; design; evidence based guidelines; health care availability; health care service; health care service utilization; health difference; health equity; health plan; health related quality of life; improved; innovation; integrated care; neglect; physical conditioning; programs; provider networks; routine practice; secondary analysis; sociodemographics

Background: With rapid acceleration of Veterans’ use of care in the community, limited data exist to prepare community providers and others in the broader VA integrated care network. Many community providers and health plans may assume Veteran patients are similar to their routine practice populations, composed primarily of civilians, although prior research would suggest otherwise. Significance/Impact: The proposed study will use detailed, current, and comprehensive data from the Behavioral Risk Factor Surveillance System (BRFSS), National Health Interview Survey (NHIS), the National Surveys on Drug Use and Health (NSDUH), and VA Corporate Data Warehouse (CDW) to quantify broadly the distribution of health and healthcare factors for Veterans, VA users, and VA non-users and to evaluate in-depth the factors that differ between Veterans and civilians. This information will not only substantially update our knowledge of how Veterans are similar to or different from civilians but will also be used by VA policymakers to improve the design and readiness of community care partners as VA referrals increase. Innovation: In contrast to previous studies and reports using national survey data, the proposed project will include VA data to provide a richer description of VA patients than is possible using only publicly-available data on VA users, and examine in depth the patterns in Veterans’ health and healthcare across subgroups and over time. The proposed research has no corollary or antecedent study in VA HSR&D’s or QUERI’s portfolio, and of the studies funded outside the VA that use one or more of these sources and is underway or recently completed, none proposed to use VA data or to combine the breadth and depth of the proposed project Specific Aims: This project aims to 1. Quantify the distribution of population characteristics, health behaviors, health conditions, health status, access to care, and healthcare utilization among Veterans overall and among VA users and non-users; 2. Evaluate the extent to which patterns in population-, health-, and healthcare- related factors differ between Veterans and civilians; 3. Determine whether the patterns identified under Aims 1 and 2 vary for subgroups defined by age, gender, and race-ethnicity; and, 4. Conduct an expert panel to review results from Aims 1-3 to come to consensus on evidence-based recommendations for improved community care (e.g., community provider readiness) and health equity. Methodology: We will conduct a secondary analysis using multiple years of data from BRFSS, NHIS, NSDUH, and VA CDW. Our analyses will include measures for Veteran and VA user status, geographic region, population characteristics, health behaviors and conditions, and healthcare outcomes, such as access, utilization, and unmet need for care. We will quantify the distribution of population-, health-, and healthcare- related factors among Veterans, VA users, and VA non-users, evaluate how these factors differ between Veterans and civilians, assess the extent to which VA use moderates differences between Veterans and civilians, and assess how patterns for Veterans differ across population subgroups. We will use modified Delphi panel methods to critically appraise findings, rate their importance, feasibility, and potential for Veteran impacts, and come to consensus on evidence-based recommendations for community care and health equity. Next Steps/Implementation: We will engage diverse stakeholders as advisors/panelists (e.g., national program office, VISN, VAMC and Veteran representatives) in design of dissemination products (e.g., fact sheets, visual abstracts) for different venues that meet end user needs in addition to traditional scientific products. Integrated into the panel process will be explicit planning for products capable of informing and supporting potential practice and policy changes and their subsequent implementation.

背景：随着社区中退伍军人使用护理的快速加速，存在有限的数据来准备 社区提供商和其他更广泛的VA综合护理网络中的其他人。许多社区提供者和 健康计划可能会假设老兵患者与常规练习人群相似，主要是 平民，尽管先前的研究将暗示其他建议。 意义/影响：拟议的研究将使用来自 行为危险因素监视系统（BRFSS），国家健康访谈调查（NHIS），国家 对药物使用和健康（NSDUH）和VA公司数据仓库（CDW）的调查，以广泛量化 退伍军人，VA用户和VA非用户的健康和医疗保健因素的分配，并评估深入 退伍军人和平民之间有所不同的因素。此信息不仅将大大更新我们的 了解退伍军人与平民的相似或不同的知识，但VA决策者也将使用 随着VA推荐的增加，改善社区护理伙伴的设计和准备就绪。 创新：与使用国家调查数据的先前研究和报告相反，该项目将 包括VA数据，以提供对VA患者的丰富描述，而不是仅使用公共数据 在VA用户上，并深入研究退伍军人的健康和医疗保健的模式 时间。拟议的研究没有在VA HSR＆D或Queri的投资组合中没有必需的研究，并且 在使用其中一种或多种来源的VA之外资助的研究中，正在进行或最近 完成后，没有提议使用VA数据或结合拟议项目的宽度和深度 具体目的：该项目的目的是1。量化人口特征，健康行为的分布， 保健状况，健康状况，获得护理和退伍军人的医疗保健利用 VA用户和非用户； 2。评估人口，健康和医疗保健中的模式的程度 退伍军人和平民之间的相关因素有所不同； 3。确定目标是否确定的模式1 与年龄，性别和种族种族定义的亚组不同，有2个不同；和，4。进行专家小组进行审查 AIMS 1-3的结果以对改善社区的循证建议达成共识 护理（例如社区提供者准备就绪）和健康公平。 方法论：我们将使用来自BRFSS的多年数据进行二级分析，NHIS， NSDUH和VA CDW。我们的分析将包括老兵和VA用户状态的措施，地理 地区，人口特征，健康行为和条件以及访问等医疗保健结果 利用和未满足的护理需求。我们将量化人口，健康和医疗保健的分布 退伍军人，VA用户和VA非用户之间的相关因素，评估这些因素如何不同 退伍军人和平民，评估VA使用的程度适度，退伍军人与退伍军人之间的差异 平民，并评估退伍军人的模式在人口亚群中如何有所不同。我们将使用修改 Delphi面板方法批判性评估发现，评估其重要性，可行性和潜力 影响，并就基于证据的社区护理和健康公平的建议达成共识。 下一步/实施：我们将与顾问/小组成员一起与潜水员的利益相关者联系（例如，国家 计划办公室，VISN，VAMC和退伍军人代表）在传播产品的设计中（例如，事实 床单，视觉摘要）除了传统科学外，还满足最终用户需求的不同企业 产品。集成到面板过程中将是针对能够告知和的产品的明确计划 支持潜在的实践和政策变化及其后续实施。