Veterans Health Services

退伍军人健康服务
  • 文章类型: Journal Article
    背景:与平民相比,在退伍军人健康管理局(VA)内接受护理的退伍军人是具有独特文化特征和医疗保健需求的独特人群。对VA以外开发的基于证据的干预措施(EBIs)的修改可能有助于使护理适应VA医疗保健系统环境或退伍军人中的特定文化规范。我们试图了解如何为退伍军人修改EBIs,以及适应是否可行和被退伍军人接受。
    方法:我们在2021年6月之前的任何时间对VA内发生的EBI适应进行了范围审查。符合条件的文章是那些研究人群包括退伍军人护理的文章,EBIs被明确定义,并从原始上下文对EBI改编进行了全面描述。数据是通过报告对循证干预措施的适应和修改框架(FRAME)的组成部分进行总结的。
    结果:我们根据搜索词检索了922篇摘要。在审查标题和摘要之后,仍有49篇文章需要全文审查;其中11篇文章(22%)符合所有纳入标准。EBI适用于心理健康(n=4),获得护理和/或护理交付(n=3),糖尿病预防(n=2),物质使用(n=2),体重管理(n=1),癌症幸存者特有的护理(n=1),和/或减少退伍军人中的犯罪累犯(n=1)。所有文章都使用了定性反馈(例如,访谈或焦点小组)与参与者进行调整。大多数研究(55%)在实施前进行了修改,规划,或试点阶段,和所有计划积极适应EBIs。
    所审查的文章使用了多种方法和框架来指导接受VA护理的退伍军人的EBI适应。有机会继续扩大EBI适应的使用,以满足退伍军人的特定需求。
    Veterans receiving care within the Veterans Health Administration (VA) are a unique population with distinctive cultural traits and healthcare needs compared to the civilian population. Modifications to evidence-based interventions (EBIs) developed outside of the VA may be useful to adapt care to the VA healthcare system context or to specific cultural norms among veterans. We sought to understand how EBIs have been modified for veterans and whether adaptations were feasible and acceptable to veteran populations.
    We conducted a scoping review of EBI adaptations occurring within the VA at any time prior to June 2021. Eligible articles were those where study populations included veterans in VA care, EBIs were clearly defined, and there was a comprehensive description of the EBI adaptation from its original context. Data was summarized by the components of the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME).
    We retrieved 922 abstracts based on our search terms. Following review of titles and abstracts, 49 articles remained for full-text review; eleven of these articles (22%) met all inclusion criteria. EBIs were adapted for mental health (n = 4), access to care and/or care delivery (n = 3), diabetes prevention (n = 2), substance use (n = 2), weight management (n = 1), care specific to cancer survivors (n = 1), and/or to reduce criminal recidivism among veterans (n = 1). All articles used qualitative feedback (e.g., interviews or focus groups) with participants to inform adaptations. The majority of studies (55%) were modified in the pre-implementation, planning, or pilot phases, and all were planned proactive adaptations to EBIs.
    The reviewed articles used a variety of methods and frameworks to guide EBI adaptations for veterans receiving VA care. There is an opportunity to continue to expand the use of EBI adaptations to meet the specific needs of veteran populations.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    在农村退伍军人医疗保健需求的独特背景下,根据《使命法》扩大美国退伍军人事务部和社区护理计划,以及2019年冠状病毒病的不确定性(COVID-19),了解什么可以支持有效的组织间护理协调以增加获得高质量护理的机会至关重要.
    我们进行了系统的审查,以检查退伍军人事务部(VA)和社区合作伙伴在照顾农村退伍军人方面所采取的组织间护理协调举措,包括挑战和机遇,组织领域塑造护理协调,其中,改善或阻碍医疗保健结果的举措。
    我们遵循系统评论和荟萃分析(PRISMA)指南的首选报告项目,以搜索2个电子数据库(PubMed和Embase),查找2009年1月至2020年5月之间发表的同行评审文章。在先前研究的基础上,我们进行了系统的审查。
    16篇文章符合我们的标准。每个人都抓住了独特的医疗保健重点,同时研究了共同的挑战。出现了四个组织领域:政策和行政,文化,机制,和关系实践。示例强调了举措如何改善或阻碍农村医疗保健的提供。
    这是第一次系统综述,根据我们的知识,通过VA和社区护理计划检查农村退伍军人的组织间护理协调。结果提供了组织间护理协调领域和计划有效性的范例。这表明合作伙伴调整协调领域的努力可以改善医疗保健,将农村作为一个关键的背景因素。调查结果对政策很重要,实践,VA和社区护理合作伙伴的研究致力于改善农村退伍军人的获取和医疗保健。
    In the unique context of rural Veterans\' health care needs, expansion of US Department of Veterans Affairs and Community Care programs under the MISSION Act, and the uncertainties of coronavirus disease 2019 (COVID-19), it is critical to understand what may support effective interorganizational care coordination for increased access to high-quality care.
    We conducted a systematic review to examine the interorganizational care coordination initiatives that Veterans Affairs (VA) and community partners have pursued in caring for rural Veterans, including challenges and opportunities, organizational domains shaping care coordination, and among these, initiatives that improve or impede health care outcomes.
    We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search 2 electronic databases (PubMed and Embase) for peer-reviewed articles published between January 2009 and May 2020. Building on prior research, we conducted a systematic review.
    Sixteen articles met our criteria. Each captured a unique health care focus while examining common challenges. Four organizational domains emerged: policy and administration, culture, mechanisms, and relational practices. Exemplars highlight how initiatives improve or impede rural health care delivery.
    This is the first systematic review, to our knowledge, examining interorganizational care coordination of rural Veterans by VA and Community Care programs. Results provide exemplars of interorganizational care coordination domains and program effectiveness. It suggests that partners\' efforts to align their coordination domains can improve health care, with rurality serving as a critical contextual factor. Findings are important for policies, practices, and research of VA and Community Care partners committed to improving access and health care for rural Veterans.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    Administrative data are increasingly used in research and evaluation yet lack standardized guidelines for constructing measures using these data. Body weight measures from administrative data serve critical functions of monitoring patient health, evaluating interventions, and informing research. This study aimed to describe the algorithms used by researchers to construct and use weight measures.
    A structured, systematic literature review of studies that constructed body weight measures from the Veterans Health Administration was conducted. Key information regarding time frames and time windows of data collection, measure calculations, data cleaning, treatment of missing and outlier weight values, and validation processes was collected.
    We identified 39 studies out of 492 nonduplicated records for inclusion. Studies parameterized weight outcomes as change in weight from baseline to follow-up (62%), weight trajectory over time (21%), proportion of participants meeting weight threshold (46%), or multiple methods (28%). Most (90%) reported total time in follow-up and number of time points. Fewer reported time windows (54%), outlier values (51%), missing values (34%), or validation strategies (15%).
    A high variability in the operationalization of weight measures was found. Improving methods to construct clinical measures will support transparency and replicability in approaches, guide interpretation of findings, and facilitate comparisons across studies.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Sci-hub)

       PDF(Pubmed)

  • 文章类型: Journal Article
    目标:创伤后应激障碍(PTSD)退伍军人的治疗利用率较低。了解患有PTSD的退伍军人的精神卫生保健的相关因素和预测因素对于促进治疗利用至关重要。然而,鉴于文献基础的规模和不同的发现,很难解释现有的研究。研究了2012年至2016年间发表的创伤后应激障碍退伍军人精神保健的相关因素和预测因素,以(a)定义最近文献的范围,(b)总结预测性证据。
    方法:这个两阶段系统综述进行了科学数据库搜索。第一阶段定义了最近文献的范围(n=51)和相关关系的列表类型,结果,和偏见的来源。第2阶段总结了前瞻性研究(n=17)评估精神卫生保健利用的结果(PROSPEROID号。CRD42017082686)。
    结果:人口统计学-社交网络特征(61%)和评估需求(61%)是心理健康利用的最常见关联。具有预测利用率(包括启动和保留)的最强证据的促进者是护理事件的特征(例如,初级保健中的心理健康)和更大的PTSD症状严重程度。有利于退伍军人事务部(VA)注册人员(92%)和排除VA护理结果(86%)的研究偏见限制了结果的普遍性。
    结论:致力于在初级保健中提供心理健康,解决心理健康信念的干预措施,与种族少数族裔退伍军人和患有轻度至中度PTSD的人接触可以提高精神卫生保健的利用率。(PsycINFO数据库记录(c)2019年APA,保留所有权利)。
    OBJECTIVE: Treatment utilization among veterans with posttraumatic stress disorder (PTSD) is low. Understanding correlates and predictors of mental health care for veterans with PTSD is critical to facilitating treatment utilization. However, given the size of the literature base and disparate findings, it is difficult to interpret available research. Correlates and predictors of mental health care for veterans with PTSD published between 2012 and 2016 were examined to (a) define the scope of recent literature and (b) summarize predictive evidence.
    METHODS: This 2-phase systematic review conducted scientific database searches. Phase 1 defined the scope of recent literature (n = 51) and tabulated types of correlates, outcomes, and sources of bias. Phase 2 summarized results from prospective studies (n = 17) evaluating mental health care utilization (PROSPERO ID No. CRD42017082686).
    RESULTS: Demographics-social network characteristics (61%) and evaluated need (61%) were the most common correlates of mental health utilization. Facilitators with the strongest evidence for predicting utilization (both initiation and retention) were characteristics of the episode of care (e.g., mental health in primary care) and greater PTSD symptom severity. Study biases favoring Department of Veterans Affairs (VA) enrollees (92%) and excluding outside VA care outcomes (86%) limit generalizability of results.
    CONCLUSIONS: Efforts focused on providing mental health in primary care, interventions to address mental health beliefs, and outreach to racial-ethnic minority veterans and those with mild to moderate PTSD could increase mental health care utilization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

公众号