Community Care Utilization among Post-9/11 Veterans with Traumatic Brain Injury

9/11 后脑外伤退伍军人的社区护理利用

• 批准号: 10884144
• 负责人: Kathleen F. Carlson
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10884144
• 关键词: Accountability; Address; Brain Concussion; Caring; Case Management; Categories; Characteristics; Chronic; Classification; Clinical; Clinical Practice Guideline; Cognitive; Community Care Networks; Community Healthcare; Complex; Data; Databases; Dementia; Department of Defense; Development; Diagnosis; Early Diagnosis; Education; Emotional; Ensure; Evaluation; Evidence based practice; Evidence based treatment; Feeling suicidal; Functional disorder; Guidelines; Health; Health Personnel; Health Services Accessibility; Healthcare; Healthcare Systems; Injury; Integrated Health Care Systems; Interview; Knowledge; Link; Measures; Medical; Mental Depression; Mental Health; Methodology; Methods; Military Personnel; Modeling; Multiple Trauma; Neurobehavioral Manifestations; Neurologic; Outcome; Outsourcing; Pain; Pain Disorder; Patient Outcomes Assessments; Pattern; Perception; Physical Medicine; Physical Rehabilitation; Post-Traumatic Stress Disorders; Process; Provider; Quality of Care; Recommendation; Recording of previous events; Research; Research Methodology; Resources; Risk; Sampling; Services; Severities; Source; Structure; Subgroup; Surveys; Symptoms; System; TBI Patients; Time; Traumatic Brain Injury; Trust; Veterans; Work; care fragmentation; care providers; care systems; combat veteran; comorbidity; daily functioning; design; disability; emotional symptom; evidence base; experience; functional outcomes; improved; innovation; mild traumatic brain injury; military service; mortality; patient population; persistent symptom; physical symptom; post 9/11; prevent; programs; research study; satisfaction; screening; sociodemographics

Background: Estimates suggest that 20% or more of Post-9/11 Veterans have experienced at least one military-related traumatic brain injury (TBI); the majority are categorized as mild (mTBI). TBI of all levels of severity, including mTBI, can lead to chronic physical, cognitive, and emotional symptoms that, for many, interfere with daily functioning. It is also associated with comorbid diagnoses such as posttraumatic stress disorder, depression, pain, dementia, and suicidal ideation. As such, early detection and coordinated treatment are critical for preventing chronic dysfunction, disability, and early mortality among Veterans with TBI history. The VA Polytrauma/TBI System of Care (PSC), through a regional, integrated structure, serves this function by overseeing and providing screening, evaluation, education, and evidence-based treatment for those in need of TBI-related care. The PSC will care for this substantial patient population for decades to come. Since the 2014 passage of the Veterans Choice Act and, more recently, the VA MISSION Act, the VA has been outsourcing larger amounts of healthcare to non-VA providers (“Community Care”). VA Community Care may improve Veterans’ access to care; however, dual use of healthcare systems and providers can lead to poor outcomes due to fragmentation of care. Preliminary work has suggested that higher proportions of Veterans with TBI diagnoses, relative to those without TBI, are receiving VA Community Care services, and that this may be leading to the receipt of therapies that are not recommended for patients with TBI. Significance/Impact: This study will inform the development and implementation of strategies to enhance the care received by Veterans with TBI who use VA Community Care services. This work will identify gaps in the provision of evidence-based TBI care in a timely manner, as VA Community Care services continue to expand under the new MISSION Act. Our results will help ensure that Veterans with TBI receive care that is coordinated, interdisciplinary, and evidence-based, and that promotes their optimal health and functioning. Innovation: This project will develop new knowledge about Community Care utilization and outcomes among Veterans receiving care for TBI, a high-priority, clinically-complex patient population. It will be the first, to our knowledge, to measure patient-reported health and functional outcomes among Veterans who receive Community Care. Additionally, we will link to multiple VA and Department of Defense (DoD) databases to objectively account for differences in characteristics between those who do and do not use Community Care. Specific Aims: Our aims are to: (1) Describe utilization of VA Community Care (rates and types of; reliance on) among Post-9/11 Veterans with TBI; (2) Estimate associations between Veterans’ reliance on Community Care and their health and functional outcomes; and (3) Understand Veterans’ need for, perceptions of, and experiences with VA Community Care. Methodology: This 4-year, mixed-methods project will link data identifying Post-9/11 Veterans with TBI to administrative data identifying VA healthcare use including Community Care. For Aim 1, we will examine patterns of Community Care use (rates and types of; reliance on) over time and by Veterans’ sociodemographics, military history, TBI severity, medical complexity, and PSC utilization history. For Aim 2, we will survey a stratified, random sample of 1,800 Veterans with TBI to estimate associations between their reliance on Community Care and their health and functional outcomes, while accounting for potential confounders and sources of bias. For Aim 3, we will interview 100 Veterans to examine factors related to their access to, satisfaction with, trust of, and actual and perceived quality of Community Care. Implementation/Next Steps: This work may identify subgroups of Veterans whose healthcare needs are not being met and who are at risk of poor outcomes. Results will inform strategies to ensure continued delivery of coordinated, high-quality care across the entire spectrum in which Veterans with TBI are receiving VA care.

背景：估计表明，9/11后退伍军人的20％或更多 与军事相关的脑损伤（TBI）；大多数被归类为轻度（MTBI）。各个级别的TBI 包括MTBI在内的严重程度可能导致慢性身体，认知和情感症状，对于许多人来说， 干扰日常功能。它也与合并症诊断（例如创伤后压力）有关 障碍，抑郁，疼痛，痴呆和自杀想法。因此，早期检测和协调治疗 对于预防具有TBI病史的退伍军人的慢性功能障碍，残疾和早期死亡率至关重要。 通过区域，集成结构的VA Polytrauma/TBI护理系统（PSC）通过 为需要的人监督和提供筛查，评估，教育和基于证据的治疗 与TBI相关的护理。 PSC将在未来几十年内照顾这个大量的患者人群。 自2014年《退伍军人选择法》和《 VA Mission Act》（VA Mission Act）以来，VA已有 将大量的医疗保健外包给非VA提供者（“社区护理”）。 VA社区护理 可能会改善退伍军人获得护理的机会；但是，医疗保健系统和提供商的双重使用可以导致 由于护理的分散，结果不佳。初步工作表明，更高的比例 相对于没有TBI的退伍军人，具有TBI诊断的退伍军人正在接受VA社区护理服务，并且 这可能导致收到不建议使用TBI患者的疗法。 意义/影响：本研究将为增强策略的制定和实施提供信息 使用VA社区护理服务的TBI退伍军人收到的护理。这项工作将确定 随着VA社区护理服务继续扩展，及时提供基于证据的TBI护理 根据新的任务法。我们的结果将有助于确保具有TBI的退伍军人受到关怀 协调，跨学科和基于证据，这促进了其最佳健康和功能。 创新：该项目将发展有关社区护理利用和成果的新知识 接受TBI护理的退伍军人，TBI是一种高优先级，临床复杂的患者人群。这将是我们的第一个 知识，以衡量接受患者报告的健康和功能结果 社区护理。此外，我们将链接到多个VA和国防部（DOD）数据库 客观地说明那些做和不使用社区护理的人之间的特征差异。 具体目的：我们的目的是：（1）描述使用VA社区护理的利用（责任的价格和类型；责任 在9/11后的退伍军人中，有TBI； （2）估计退伍军人对社区依赖的关联 护理及其健康和功能结果； （3）了解退伍军人的需求，对 VA社区护理的经验。 方法论：这个四年的混合方法项目将将识别9/11后退伍军人的数据链接到TBI 识别包括社区护理在内的VA医疗保健的行政数据。对于AIM 1，我们将检查 随着时间的推移和退伍军人 社会人口统计学，军事史，TBI严重性，医学复杂性和PSC利用历史。对于目标2， 我们将调查1,800名具有TBI的退伍军人的分层，随机样本，以估计其之间的关联 依赖社区护理及其健康和功能成果，同时考虑潜在 偏见的混杂因素和来源。对于AIM 3，我们将采访100名退伍军人，以检查与他们的因素 访问，满意，信任，实际和感知的社区护理质量。 实施/下一步：这项工作可能会识别其医疗保健需求的退伍军人的亚组 被满足并有不良结果的风险。结果将为策略提供信息，以确保继续交付 在整个TBI的退伍军人接受VA护理的整个范围内，协调的高质量护理。