BACKGROUND/RATIONALE:
Access to mental health (MH) care continues to be a challenging issue for VHA. A VA State-of-the-Art Conference (SOTA) in September 2010 on the topic of "Improving Access to VA Care" created a perceived access framework which included five conceptual domains (i.e., geographical, temporal, financial, cultural and digital). To our knowledge, none of the available access measures encompasses all five of these domains. In particular, the perceived access to digital or e-health encounters is absent from existing measures. The first SOTA research recommendation was to develop and validate actual and perceived metrics of Veteran-centered access to VA and non-VA services.

OBJECTIVE(S):
The overall objective of this proposal is to generate a psychometrically sound patient-centered measure of Veterans' perceived access to MH treatments, with particular attention to the intersection of perceived access and e-health technologies.

METHODS:
We will accomplish this by (1) collecting qualitative data from VA patients about their experience considering or accessing mental health services in order to generate survey items that are informed by the SOTA Access model, (2) assessing the content validity of the items and constructing a preliminary version of the Perceived Access Inventory (PAI), and (3) evaluating (concurrent and predictive validity and reliability) and refining a final version of the PAI. We will recruit VA patients from community-based outpatient clinics in three VA Networks (VISNs): Arkansas, Maine, and Northern California. We will conduct qualitative interviews with approximately 90 VA patients and ask them about their perceived access to mental health services using the SOTA Access framework to structure the interviews. We will use content analysis methods including an expert panel to construct a preliminary version of the PAI and then administer this instrument to a sample of 100 VA CBOC patients to evaluate the validity and reliability of this measure and perform analyses for potential item reduction. A fourth aim was added to collect qualitative data from Veterans using Choice Act community care for mental health treatment to see if any items needed to be added to the PAI that are specific to accessing community care mental health services.

FINDINGS/RESULTS:
Transcripts from 80 Veterans across 3 VISNs were coded, internal expert panel review and external expert panel modified Delphi panel were completed. Qualitative data and existing access items were used to generate 240 items that addressed all five SOTA domains and two additional domains (healthcare systems and experiences of care). The initial 240 items were reduced to 40 through consolidation by the research team and two rounds of external Delphi process. Following Veteran/patient pilot testing, the final version of the PAI has 43 items in six domains (logistics (combines geographical, temporal, financial from SOTA model)=5 items, culture=3, digital=9, systems=13, and experiences of care=13). Separate versions are available for Veterans who used VA mental health services within the past year, those who used services more than a year ago, and those who have never used VA mental health services. Additional work is ongoing for a version that will be specific to the use of Choice Act mental health services..

IMPACT:
Although instruments are available to measure perceived geographical, temporal, financial, and cultural access to care, we are not aware of any that address access to e-health or were developed with extensive Veteran patient input. The PAI will provide a perceived access measure that will allow policy makers and researchers to identify populations and facilities for future quality improvement and treatment engagement efforts and directly measure the impact of these efforts. We will also be able to validate the VA State of the Art (SOTA) Access model with the cultural domain analysis from these data. We are working with Central Office partners throughout this project. We will also examine the need for Choice Act specific PAI questions..

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External Links for this Project

NIH Reporter

Grant Number: I01HX001114-01
Link: https://reporter.nih.gov/project-details/8486277

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PUBLICATIONS:

Journal Articles

1. Miller CJ, Kim B, Silverman A, Bauer MS. A systematic review of team-building interventions in non-acute healthcare settings. BMC health services research. 2018 Mar 1; 18(1):146. [view]
2. Fortney JC, Unützer J, Wrenn G, Pyne JM, Smith GR, Schoenbaum M, Harbin HT. A Tipping Point for Measurement-Based Care. Psychiatric services (Washington, D.C.). 2017 Feb 1; 68(2):179-188. [view]
3. Pyne JM, Kelly PA, Fischer EP, Miller CJ, Wright P, Zamora K, Koenig CJ, Stanley R, Seal K, Fortney JC. Development of a Perceived Access Inventory for Community Care Mental Healthcare Services for Veterans. Military medicine. 2019 Jul 1; 184(7-8):e301-e308. [view]
4. Pyne JM, Kelly PA, Fischer EP, Miller CJ, Wright P, Zamora K, Koenig CJ, Stanley R, Seal K, Burgess JF, Fortney JC. Development of the Perceived Access Inventory: A patient-centered measure of access to mental health care. Psychological Services. 2020 Feb 1; 17(1):13-24. [view]
5. Pyne JM, Kelly PA, Fischer EP, Miller CJ, Connolly SL, Wright P, Zamora K, Koenig CJ, Seal KH, Fortney JC. Initial concurrent and convergent validity of the Perceived Access Inventory (PAI) for mental health services. Psychological Services. 2022 Feb 1; 19(1):118-124. [view]
6. Fortney JC, Pyne JM, Burgess JF. Population-level cost-effectiveness of implementing evidence-based practices into routine care. Health services research. 2014 Dec 1; 49(6):1832-51. [view]
7. Miller CJ, Burgess JF, Fischer EP, Hodges DJ, Belanger LK, Lipschitz JM, Easley SR, Koenig CJ, Stanley RL, Pyne JM. Practical application of opt-out recruitment methods in two health services research studies. BMC medical research methodology. 2017 Apr 14; 17(1):57. [view]
8. Cheney AM, Koenig CJ, Miller CJ, Zamora K, Wright P, Stanley R, Fortney J, Burgess JF, Pyne JM. Veteran-centered barriers to VA mental healthcare services use. BMC health services research. 2018 Jul 31; 18(1):591. [view]
9. Connolly SL, Miller CJ, Koenig CJ, Zamora KA, Wright PB, Stanley RL, Pyne JM. Veterans' Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences. JMIR mHealth and uHealth. 2018 Aug 22; 6(8):e10748. [view]
10. Bovin MJ, Miller CJ, Koenig CJ, Lipschitz JM, Zamora KA, Wright PB, Pyne JM, Burgess JF. Veterans' experiences initiating VA-based mental health care. Psychological Services. 2019 Nov 1; 16(4):612-620. [view]

Conference Presentations

1. Beatty AL, Fortney JC. Regional Variation in Cardiac Rehabilitation Participation within the Medicare and Veterans Health Administration Populations. Paper presented at: American Heart Association Annual Scientific Sessions; 2015 Nov 9; Orlando, FL. [view]

DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Treatment - Observational, Technology Development and Assessment, Research Infrastructure, Diagnosis
Keywords: Attitudes/Beliefs, Rural, Telemedicine/Telehealth
MeSH Terms: none