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Principal Investigator: AUDREY L JONES
Organization: VA SALT LAKE CITY HEALTHCARE SYSTEM
Fiscal Year: 2024
Funding agency: Veterans Affairs
Background: My long-term goal is to become an independent VA health services researcher focused on
designing and testing integrated care solutions to improve mental health and substance abuse (MHSA) services
access, quality, and outcomes for vulnerable Veteran populations. This CDA-2 will provide me with the
necessary mentorship, skills, and experiences to evaluate, modify and implement organizational changes that
improve MHSA outcomes for vulnerable Veterans in primary care settings.
Significance/Impact: Veterans who have been homeless have high rates of depression and opioid use
disorder and barriers to accessing traditional primary care services. It is important to determine effective models
of MHSA services integration at this time when Veterans have more options for care in VA and community
settings. VA’s homeless patient aligned care team (H-PACT) program, implemented in over 60 VA facilities,
offers a natural laboratory to determine optimal approaches of MHSA services integration to advance Veteran
health. My research will impact Veteran health by determining the effectiveness of H-PACT for providing high
quality MHSA care and mitigating adverse MHSA outcomes among homeless-experienced Veterans; and by
determining the unique and potentially modifiable aspects of H-PACT and other patient aligned care teams
(PACTs) that could be scaled to achieve superior MHSA outcomes for homeless-experienced Veterans in
specialized and non-specialized PACT settings. This research strongly aligns with VA research priorities of
mental health and primary care, and legislative priorities related to addiction recovery and community care.
Innovation: While prior studies suggest H-PACT improves primary care utilization and Veteran experiences
with care, there is less research focused on determining what features of H-PACT are successful. We lack data
on clinical process measures and outcomes for Veterans empaneled in H-PACTs, information on aspects of
MHSA services integration that exists within H-PACTs and traditional PACTs caring for homeless-experienced
Veterans, and the barriers and facilitators that contribute to MHSA quality for homeless-experienced Veterans.
Specific Aims: My CDA-2 has three primary aims: 1) Compare MHSA services quality of care (e.g., clinical
performance measures for depression, opioid use disorder) and outcomes (e.g., psychiatric hospitalization,
opioid-related overdose, suicide) for homeless-experienced Veterans empaneled in H-PACTs versus other
PACTs in the same facilities; 2) Measure levels and features of MHSA services integration (e.g., coordination
with community services, co-location of providers, full integration) for homeless-experienced Veterans in H-
PACTs and other PACTs; and 3) Evaluate MHSA service practices and barriers in 4 facilities ranked low and 4
ranked high on measures of MHSA services quality for homeless-experienced Veterans. I will work with my
mentors to develop the expertise to study MHSA services quality in primary care settings, and to augment my
foundational training with new skills in survey design, qualitative methods and implementation science.
Methodology: I aim to 1) use VA administrative data to operationalize MHSA services quality of care based
on VA performance measures and established definitions; 2) adapt an organizational survey of H-PACT
structures to survey providers from H-PACTs and PACTs about how MHSA services integration is achieved for
homeless-experienced Veterans, and; 3) conduct stakeholder interviews in low and high performing facilities to
identify barriers to delivering high quality MHSA services for homeless-experienced Veterans.
Next Steps/Implementation: Findings will provide information to VA providers, operational partners, and
leadership about the effectiveness of the H-PACT initiative, and targets for intervention to bolster lower
performing H-PACTs. My pre-implementation research findings and training experiences will inform my future
work focused on MHSA outcomes in specialized PACT settings, including an HSR&D effectiveness-
implementation study (IIR) application to improve MHSA services quality for homeless Veterans in PACTs.
Terms: <Access to Care><Adopted><Caring><Clinical><Community Health Care><Community Healthcare><Community Services><Data><Disease><Disorder><ED visit><ER visit><Effectiveness><Elements><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room visit><Enrollment><Environment><Fellowship><Future><Goals><Guidelines><Health><Health Services><Health Services Accessibility><History><Homelessness><Homogeneously Staining Region><Intervention><Intervention Strategies><Interview><Investigators><Investments><Laboratories><Lead><Leadership><Major Depressive Disorder><Measures><Mental Depression><Mental Health><Mental Health Services><Mental Hygiene><Mental Hygiene Services><Mentors><Mentorship><Methodology><Methods><Modeling><Organizational Change><Outcome><Overdose><Patients><Pb element><Performance><Population><Postdoc><Postdoctoral Fellow><Preparation><Primary Care><Process Measure><Provider><Psychological Health><Publishing><QOC><Qualitative Methods><Quality of Care><Recording of previous events><Recovery><Reporting><Research><Research Associate><Research Personnel><Research Priority><Researchers><Risk><Science><Services><Site><Social Service><Social Work><Specialist><Structure><Substance abuse problem><Suicide><Survey Instrument><Surveys><Testing><Time><Training><United States Department of Veterans Affairs><United States Veterans Administration><Variant><Variation><Veterans><Veterans Administration><Veterans Affairs><Veterans Health Administration><Veterans Health Affairs><Work><abuse of substances><access to health services><access to services><access to treatment><accessibility to health services><addiction><addictive disorder><assess effectiveness><availability of services><care access><care delivery><clinical depression><community care><community setting><comparative><depression><design><designing><determine effectiveness><effectiveness assessment><effectiveness evaluation><effectiveness/implementation hybrid study><effectiveness/implementation study><enroll><evaluate effectiveness><evidence base><examine effectiveness><experience><fatal attempt><fatal suicide><health service access><health services availability><heavy metal Pb><heavy metal lead><high risk><histories><homeless><hsr><implementation design><implementation efforts><implementation framework><implementation research><implementation research design><implementation research framework><implementation science><implementation science framework><implementation study><improved><improved outcome><innovate><innovation><innovative><inpatient psychiatric care><inpatient psychiatric treatment><integrated care><integrated model of care><intent to die><intervention design><interventional strategy><major depression><major depression disorder><mental health care><mental healthcare><military veteran><opiate overdose><opiate related overdose><opiate use disorder><opioid drug overdose><opioid induced overdose><opioid intoxication><opioid medication overdose><opioid overdose><opioid poisoning><opioid related overdose><opioid toxicity><opioid use disorder><post-doc><post-doctoral><post-doctoral trainee><preparations><primary care services><primary care setting><primary care team><primary care visit><programs><psychiatric hospitalization><qualitative reasoning><research associates><service availability><service coordination><skills><substance abuse><substance abuse therapy><substance abuse treatment><suicides><therapy design><treatment access><treatment design><unhoused><veteran population>