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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3023 — A Location-Transportation Model for Post-Traumatic Stress Disorder Services across VISN 1

Shiner B, NCPTSD, VERC; Musdal H, and Ceyhan ME, Northeastern University, VERC; Watts BV, NCPS, VERC; Benneyan JC, Northeastern University, VERC;

The VHA has made significant investments in the use of video-based telemedicine with the goal of improving access to mental health care. However, it is sometimes the geographic distribution of providers as much as the geographic distribution of patients that determines whether services are delivered in person or via video. With the development of effective treatments for PTSD, access to evidence-based services has become especially important. Quantitative operations research methods to determine the optimal geographic location of these services may lead to a more patient-centered balance between the use of in-person and video-based services.

We determined the location of VA users with PTSD in New England using administrative data from the VISN 1 Data Warehouse, and clustered them by 3-digit zip code. For each cluster, we determined the service requirements to deliver both initial evidence-based PTSD care and ongoing treatment for the portion unlikely to remit. Taking into account non-PTSD mental health services workload based on diagnostic information for all Veterans in VISN 1, we used operations research models to determine the total amount of mental health manpower to serve each cluster. Each cluster was assigned to a VA facility (hospital, CBOC, or outreach clinic) within 30 miles. For each facility, we determined whether there was sufficient local demand to fully utilize in-person services. Facilities without sufficient local demand were considered candidates for video-based services.

Most geographic regions in VISN 1 have sufficient mental health service need to locate mental health providers who are expert in evidence-based PTSD services at existing facilities, CBOCs, and outreach clinics. Several areas, however, including Central Vermont, Southwestern New Hampshire, and much of Northern Maine, would be more efficiently served by locating video-based services at existing facilities.

In most areas in VISN 1, access to evidence-based PTSD services could be accomplished with efficient need-based distribution of mental health providers. However, in several regions, there is insufficient need to fully utilize mental health providers. In these cases, the location use of video-based mental health services may be the most appropriate intervention.

Operations research and systems engineering methods appear useful to help inform these types of macro system design and policy issues.

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