Medical Care最新文献_第4页

Veterans' Experiences of and Preferences for Patient-Centered, Measurement-Based PTSD Care. 退伍军人对以患者为中心、基于测量的创伤后应激障碍护理的体验和偏好。

IF 4.3 2区医学

Medical Care Pub Date : 2024-12-01 Epub Date: 2024-11-11 DOI: 10.1097/MLR.0000000000002070

Marcela C Weber, Ashlyn M Jendro, Ellen P Fischer, Karen L Drummond, Trenton M Haltom, Natalie E Hundt, Michael A Cucciare, Jeffrey M Pyne

{"title":"Veterans' Experiences of and Preferences for Patient-Centered, Measurement-Based PTSD Care.","authors":"Marcela C Weber, Ashlyn M Jendro, Ellen P Fischer, Karen L Drummond, Trenton M Haltom, Natalie E Hundt, Michael A Cucciare, Jeffrey M Pyne","doi":"10.1097/MLR.0000000000002070","DOIUrl":"10.1097/MLR.0000000000002070","url":null,"abstract":"Background: Up to 50% of veterans drop out of trauma-focused evidence-based psychotherapies (TF-EBP) without completing treatment or recovering; evidence suggests this is in part because their posttraumatic stress disorder (PTSD) care is insufficiently patient-centered. There is also evidence that measurement-based care (MBC) for mental health should be personalized to the patient, yet this is not common practice in VA PTSD care.Objectives: To explore veterans' experiences and preferences for aligning measurement-based PTSD care with their own treatment goals.Method: Qualitative interviews were conducted with veterans (n=15) with PTSD who had received at least 2 sessions of a TF-EBP.Measures: Survey on the administration of outcomes questionnaires and demographics and an interview about their most recent TF-EBP episode.Results: Half of veterans had symptom-focused goals and half did not; all had at least one treatment goal that was not symptom-focused. They typically met their goals about functioning and coping skills but not their symptom reduction goals. We found veterans overall were receptive to MBC but preferred patient-reported outcomes measures about functioning, wellbeing, coping skills, and understanding their trauma more than the commonly used PTSD symptom scale (the PCL-5).Conclusions: Many veterans in this sample disliked the PCL-5 because it reinforced their maladaptive cognitions. Such veterans might be more receptive to MBC if offered patient-report outcomes measures that better align with their functional and wellbeing goals. For many goal/outcome areas, psychometrically sound measures exist and require better implementation in PTSD care. For some areas, scale development is needed.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"62 12 Suppl 1","pages":"S84-S90"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Suicide Rates by Age and Time Among American Indian and Alaskan Native Veterans. 按年龄和时间划分的美国印第安人和阿拉斯加原住民退伍军人自杀率。

IF 3.3 2区医学

Medical Care Pub Date : 2024-12-01 Epub Date: 2024-10-03 DOI: 10.1097/MLR.0000000000002073

Lisa A Brenner, Christin N Miller, Alexandra L Schneider, Claire A Hoffmire, Charlotte McCloskey, Jeri E Forster

{"title":"Suicide Rates by Age and Time Among American Indian and Alaskan Native Veterans.","authors":"Lisa A Brenner, Christin N Miller, Alexandra L Schneider, Claire A Hoffmire, Charlotte McCloskey, Jeri E Forster","doi":"10.1097/MLR.0000000000002073","DOIUrl":"10.1097/MLR.0000000000002073","url":null,"abstract":"Objective: Although recent work has highlighted high rates of suicide among American Indian and Alaska Native individuals who served in the US military, to date, a comprehensive evaluation of age-specific suicide rates, over time, has yet to be conducted.Methods: Population-based retrospective cohort study. Average annual suicide rates (2005-2020) were computed. The cohort included 207,955 Native Veterans who were alive as of January 1, 2005, and separated from military service on or before December 31, 2020. Suicide was identified via National Death Index codes.Results: Between 2005 and 2020, average annual, age-specific suicide rates among Native Veterans ranged from 16.32/100,000 (55+ y) to 64.49/100,000 (18-34 y). Compared with other age-related cohorts, the rate among those in the youngest age cohort (18-34y) was the highest between 2005 and 2018. The 2019-2020 average annual rate for 18- to 34-year-olds (41.86/100,000) dropped below that of the middle-aged cohort (35-45 y; 44.66/100,000). Across all age cohorts, firearms were the most used method of suicide [57.2% (18-34 and 35-54 y) to 66.17% (55+y)]; however, a notable percentage of Veterans died by suffocation, 16.54% (55 y and older), 26.71% (35-54 y), and 33.21% (18-34 y).Conclusions: Findings highlight differences in suicide rates by age groups overtime for Native Veterans irrespective of Veterans Health Administration use and across service eras, as well as means of suicide, which also differed across groups. Increased efforts are needed to identify culturally and age-relevant intervention strategies, as well as factors associated with risk, to reduce deaths among Native Veterans.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"62 12","pages":"798-802"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating the Impact of a Peer Support Program on Participants' Well-Being: Finding Belongingness Through the Women Veterans Network. 评估同伴支持计划对参与者幸福感的影响：通过女退伍军人网络寻找归属感。

IF 4.3 2区医学

Medical Care Pub Date : 2024-12-01 Epub Date: 2024-11-11 DOI: 10.1097/MLR.0000000000002039

Tara E Galovski, Amy E Street, Caroline C Cooney, Michael R Winters

{"title":"Evaluating the Impact of a Peer Support Program on Participants' Well-Being: Finding Belongingness Through the Women Veterans Network.","authors":"Tara E Galovski, Amy E Street, Caroline C Cooney, Michael R Winters","doi":"10.1097/MLR.0000000000002039","DOIUrl":"10.1097/MLR.0000000000002039","url":null,"abstract":"Background: Loss of belongingness may be particularly pronounced for women veterans, representing a threat to long-term well-being. Improvements in social support through engagement in a structured peer support program may mitigate the negative effects of loss of belongingness on well-being.Objective: We assessed the impact of participation in a peer-led, structured, social support group-based network on outcomes related to well-being [i.e., belongingness, social support, quality of life, posttraumatic stress disorder (PTSD), depression]. Subgroup analyses examined relative impact among those who completed the intervention and those reporting clinical levels of PTSD and depression symptoms.Methods: We analyzed survey data consisting of reliable and valid measures collected at baseline, postgroup and 3-month follow-up among 393 participants in the Woven Veterans Network's (WoVeN) group program.Results: We observed improvements in posttraumatic stress disorder (PTSD) symptoms over time. We observed additional benefits among those who received an adequate dose of the intervention (significant improvements on PTSD, belongingness) and those with clinical levels of mental health symptoms (significant improvements on PTSD, depression, belongingness, quality of life).Conclusions: Impacts on social support may have been masked due to ceiling effects given wide dispersion baseline social support in this sample. This social support network had particularly profound impacts on well-being for those veterans who suffered from conditions for which isolation and loneliness are particularly salient.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"62 12 Suppl 1","pages":"S43-S49"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is the PHQ-2 a Good Measure to Inform Providers About Patient Well-Being and Functioning? Data From the Veterans Health and Life Survey. PHQ-2是向医护人员提供患者健康和功能信息的良好测量方法吗？退伍军人健康与生活调查数据。

IF 4.3 2区医学

Medical Care Pub Date : 2024-12-01 Epub Date: 2024-11-11 DOI: 10.1097/MLR.0000000000002069

David E Reed, Charles C Engel, Scott Coggeshall, Martha Michel, Bella Etingen, Rendelle E Bolton, Kurt Kroenke, Barbara G Bokhour, Steven B Zeliadt

{"title":"Is the PHQ-2 a Good Measure to Inform Providers About Patient Well-Being and Functioning? Data From the Veterans Health and Life Survey.","authors":"David E Reed, Charles C Engel, Scott Coggeshall, Martha Michel, Bella Etingen, Rendelle E Bolton, Kurt Kroenke, Barbara G Bokhour, Steven B Zeliadt","doi":"10.1097/MLR.0000000000002069","DOIUrl":"10.1097/MLR.0000000000002069","url":null,"abstract":"Background: Health care systems are increasingly focused on assessing patient well-being and functioning. The objective of the current analysis was to evaluate a pragmatic question: to what extent and in what way can the PHQ-2, a routinely collected screening measure, be used to help clinicians and a learning health system understand the well-being and functioning of its beneficiaries?Methods: The current analysis focused on 2872 Veterans who completed a large-scale longitudinal survey about health and wellness for whom we were able to link survey responses to PHQ-2 scores recorded in their electronic health records (EHR). Regression analyses examined the cross-sectional and longitudinal associations between PHQ-2 scores recorded in the EHR and measures of well-being (life satisfaction, purpose in life, and social health) and functioning (pain severity and interference, physical and mental health, and perceived stress).Results: Veterans were aged 65 years on average (11% women). PHQ-2 scores were correlated cross-sectionally with all well-being and functioning measures; however, there was minimal variance accounted for. Changes in the PHQ-2 over time were associated with 3 measures: purpose in life (b = -0.19; 95% CI: -0.34, -0.04), mental health functioning (b = -0.29, 95% CI: -0.54, -0.04), and perceived stress (b = 0.13; 95% CI: 0.02, 0.24).Conclusions: The PHQ-2 was minimally associated with patient well-being and functioning, with more work needed on how the PHQ-2 may be used in large health care settings within the context of VA Whole Health. Assessment of well-being is critical as VA's Whole Health transformation continues, and identifying strategies for well-being measurement is an integral next step.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"62 12 Suppl 1","pages":"S76-S83"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Specific, Measurable, Action-Oriented, Realistic, and Timed Goals and the Personal Health Inventory in a Wellness Group for Veterans With GWI. 具体、可衡量、以行动为导向、现实、有时间限制的目标和个人健康量表在退伍军人健康小组中的应用。

IF 3.3 2区医学

Medical Care Pub Date : 2024-12-01 Epub Date: 2024-09-03 DOI: 10.1097/MLR.0000000000002044

Maria McQuade, Craig P Polizzi, Emma Katz, Maria Ting, Cameron Busser, Matthew Paszkiewicz, DeAnna L Mori, Barbara L Niles

{"title":"Specific, Measurable, Action-Oriented, Realistic, and Timed Goals and the Personal Health Inventory in a Wellness Group for Veterans With GWI.","authors":"Maria McQuade, Craig P Polizzi, Emma Katz, Maria Ting, Cameron Busser, Matthew Paszkiewicz, DeAnna L Mori, Barbara L Niles","doi":"10.1097/MLR.0000000000002044","DOIUrl":"10.1097/MLR.0000000000002044","url":null,"abstract":"Background: Interventions based on the Veterans Health Administration's (VHA) Whole Health (WH) initiative may be beneficial for veterans with Gulf War Illness (GWI) through specific, measurable, action-oriented, realistic, and timed (SMART) goal setting and monitoring of perceived goal attainment with the Personal Health Inventory (PHI).Objectives: This secondary analysis of 2 randomized controlled trials focused on (1) categorizing SMART goals set during a wellness intervention based on the VHA's WH approach to identify goals most relevant for veterans with GWI and chronic pain and (2) descriptively examining the PHI over a course of treatment to assess its preliminary sensitivity to change. Also, changes in PHI for those who engaged in the intervention in-person versus remotely were compared.Subjects: Participants were 49 veterans with GWI and chronic pain who received a 12-week, 24-session group wellness intervention delivered in-person or remotely due to the COVID-19 pandemic.Results: SMART goal themes mapped onto the 8 areas of self-care presented in the WH program's circle of health with high categorical adherence. Most participants set goals in categories for working the body, food and drink, and personal development. The wellness intervention was related to improvements in perceived goal attainment as measured by the PHI in both in-person and remote participants, which indicates that the PHI may be sensitive to change over time.Conclusions: These preliminary findings set the stage for future research on wellness interventions for veterans with GWI and chronic pain and the measurement of whole-person outcomes.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"62 12 Suppl 1","pages":"S65-S72"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Differences in Exposures to Adverse Childhood Experiences by Primary Source of Health Care, Behavioral Risk Factor Surveillance System 2019-2020. 行为危险因素监测系统 2019-2020 年按主要医疗保健来源划分的童年不良经历暴露差异。

IF 3.3 2区医学

Medical Care Pub Date : 2024-12-01 Epub Date: 2024-10-08 DOI: 10.1097/MLR.0000000000002067

Alina W Yang, John R Blosnich

{"title":"Differences in Exposures to Adverse Childhood Experiences by Primary Source of Health Care, Behavioral Risk Factor Surveillance System 2019-2020.","authors":"Alina W Yang, John R Blosnich","doi":"10.1097/MLR.0000000000002067","DOIUrl":"10.1097/MLR.0000000000002067","url":null,"abstract":"Objectives: To estimate the prevalence of adverse childhood experiences (ACEs) among a population-based sample of adults in the United States by their primary source of health care.Background: Debate continues around the effectiveness and implementation of health care-based screening of ACEs. However, it is unclear how the burden of ACEs would be distributed across different sources of health care (ie, what a health system might expect should it implement ACEs screening).Methods: Data are from 8 U.S. states that include optional modules for ACEs and health care utilization in their 2019 or 2020 Behavioral Risk Factor Surveillance System survey. The analytic sample includes respondents with completed interviews (n = 45,820). ACEs were categorized into ordinal categories of 0, 1, 2, 3, or ≥4; and the prevalence of ACEs was summarized across 5 sources of health care: (1) employer-based or purchased plan; (2) Medicare, Medicaid, or other state programs; (3) TRICARE, Veterans Affairs, or military (ie, military-related health care); (4) Indian Health Service; or (5) some other source. All estimates were weighted to account for the complex sampling design.Results: Across all health insurance types, at least 60% of individuals reported at least one ACE. The greatest prevalence of patients reporting ≥4 ACEs occurred for military-related health care (21.6%, 95% CI = 18.2-25.5) and Indian Health Service (45.4%, 95% CI = 22.6-70.3).Conclusions: ACEs are extremely common across sources of health care, but some health systems have greater proportions of patients with high ACE exposures. The unique strengths and challenges of specific health care systems need to be integrated into the debate about clinical ACEs screening.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"809-813"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Health and Well-Being: Distinct and Intertwined Concepts. 健康与幸福：既有区别又相互交织的概念。

IF 3.3 2区医学

Medical Care Pub Date : 2024-12-01 Epub Date: 2024-11-11 DOI: 10.1097/MLR.0000000000002061

Helene M Langevin

引用次数: 0

Cultural Transformation of the International Statistical Classification of Diseases and Related Health Problems' Guidelines Needed to Effectively Measure Well-Being. 国际疾病和相关健康问题统计分类 "指南需要进行文化变革，以有效衡量幸福感。

IF 4.3 2区医学

Medical Care Pub Date : 2024-12-01 Epub Date: 2024-11-11 DOI: 10.1097/MLR.0000000000002049

Dina Hooshyar, Maria Bruton

{"title":"Cultural Transformation of the International Statistical Classification of Diseases and Related Health Problems' Guidelines Needed to Effectively Measure Well-Being.","authors":"Dina Hooshyar, Maria Bruton","doi":"10.1097/MLR.0000000000002049","DOIUrl":"10.1097/MLR.0000000000002049","url":null,"abstract":"A cultural transformation is underway at the Veterans Health Administration and other health care systems to address the well-being of the whole person and not just their disease states. A part of this evolution is to develop a measurement paradigm because the existing ones are generally disease-specific; however, the International Statistical Classification of Diseases and Related Health Problems (ICD)-10th Revision-Clinical Modification does include codes for social determinants of health (SDOH). The ICD coding system is an internationally recognized system to identify and classify diseases, injuries, health encounters, and inpatient procedures. Medical and social service providers, researchers, health information managers, public health and health care system professionals, policymakers, and coders use these codes to conduct surveillance, such as on the existence of diseases and their outcomes, health care utilization, and health care-associated adverse events, and for billing and claims reimbursement. The ICD coding system has been the backbone of health care systems' clinical documentation and coding practices on an international level since 1909. Clinical documentation and coding have an immense influence on what can be measured in medical records. The current ICD guidance needs to undergo a cultural transformation to have parity between codes for medical and nonmedical conditions, such as supporting the standard use of SDOH as primary diagnoses for outpatient encounters, expanding its list of SDOH codes, and incorporating a wellness perspective. Developing a measurement paradigm that assesses the well-being of the whole person must involve in tandem revising the ICD coding system to include this same perspective.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"62 12 Suppl 1","pages":"S30-S33"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Perspective on the Measurement of Whole Person Health. 衡量全人健康的视角。

IF 4.3 2区医学

Medical Care Pub Date : 2024-12-01 Epub Date: 2024-11-11 DOI: 10.1097/MLR.0000000000002047

Patricia M Herman, Anthony Rodriguez, Maria Orlando Edelen, Graham DiGuiseppi, Chengbo Zeng, Ian D Coulter, Ron D Hays

引用次数: 0

Applying Concepts of Successful Aging in Measuring and Promoting Whole Person Health. 将成功老龄化的概念应用于衡量和促进全人健康。

IF 4.3 2区医学

Medical Care Pub Date : 2024-12-01 Epub Date: 2024-11-11 DOI: 10.1097/MLR.0000000000002040

Jack Tsai, Audrey L Jones

{"title":"Applying Concepts of Successful Aging in Measuring and Promoting Whole Person Health.","authors":"Jack Tsai, Audrey L Jones","doi":"10.1097/MLR.0000000000002040","DOIUrl":"10.1097/MLR.0000000000002040","url":null,"abstract":"Countries around the world have large aging adult populations. There is wide public health concern about the health and well-being of aging adults, and a movement to transform healthcare systems to become age-friendly. The concept of \"successful aging\" recognizes the importance of aging and expands the goal beyond the absence of disease to functioning and well-being. In this perspective, we discuss aging as a part of life that should be considered in whole person health and cite work with the US veteran population as an example of how successful aging and age-friendly practices can be incorporated into whole person health for adult populations. We also review studies of successful aging that may offer important ways to define and measure whole person health and discuss how it might be instructive to assess successful aging with multiple indicators across the adult life span, particularly in underserved populations at-risk of premature aging and poor health. Finally, we conclude with a discussion of the \"life course perspective\" that may serve as a useful model for the interplay between successful aging and whole person health.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"62 12 Suppl 1","pages":"S21-S23"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0