Abstract

Significance to VA: The United States (U.S.) is in the midst of a substance use disorder (SUD) crisis with rates of overdose and alcoholic liver disease skyrocketing. Indigenous people (defined as individuals who identify as American Indian, Alaskan Native, Native Hawaiian, or Pacific Islander) suffer disproportionately from the effects of SUDs and have identified substance use as one of the most urgent health issues within their communities. Unfortunately, treatment for SUDs is profoundly limited in the U.S. with only 9% of all people with a SUD diagnosis receiving any treatment. Veterans Affairs (VA) prioritizes delivering timely access to high quality care for every eligible Veteran. However, data on the quality of VA SUD care for Indigenous Veterans specifically is limited. Gathering such information is an essential first step to understanding gaps in quality and developing strategies to address identified gaps. This proposal will fill a gap in our understanding of the current state of VHA SUD treatment for Indigenous Veterans and gather community members' input on potential strategies to improve care quality in ways that address community needs while also considering the feasibility and generalizability of those strategies to the VA system as a whole. Innovation and Impact: This work is innovative in that it will provide detailed data on VHA SUD treatment specifically for Indigenous Veterans. Little is known about SUD treatment experience in this group as they have traditionally been either dropped from data analysis or lumped into an “other” category because of their small numbers. This proposal is also innovative in bringing implementation science and community-based participatory research expertise and methods to develop feasible strategies to enhance engagement with, quality of, and cultural relevance of VA SUD treatment for Indigenous Veterans. Throughout the project, investigators will collaborate with VA operational partners and with their Community Advisory Board to ensure findings are relevant and actionable. The proposed work will contribute to Indigenous Veteran health and VA healthcare by characterizing the delivery of SUD care services for this group and identifying gaps to target in future initiatives to optimize SUD care quality. Specific Aims: The objective of this project is to assess VHA SUD care quality for Indigenous Veterans and develop specific recommendations to improve quality of care. Specific Aims are to (1) convene a Community Advisory Board of Indigenous Veterans with lived experience of SUDs, VA SUD providers who identify as Indigenous and/or work directly with Indigenous Veterans, and tribal leaders to align Indigenous Veterans' experiences with the research efforts and develop an action plan; (2) determine the quality of SUD care among Indigenous Veterans benchmarked against other racial/ethnic groups using established process quality measures and VA standards of care; and (3) examine Indigenous Veterans' experiences with SUD treatment through a national survey and qualitative interviewing to inform quality improvement recommendations. Methodology: This study will use multiple methods to develop the most comprehensive understanding of current care quality and potential care improvement strategies. Community-based participatory research methods will be used to guide Community Advisory Board activities throughout the project to inform recommendations and disseminate results. Aim 2 is a quantitative observational study utilizing VA administrative databases to characterize current SUD treatment quality. Aim 3 includes a quantitative national survey combined with qualitative interviews to understand Veteran experiences of SUD care. Path to Translation/Implementation: Findings will result in an action plan of feasible, generalizable recommendations to improve VA SUD treatment quality for Indigenous Veterans. The investigators have a well- established, long-term record of working with the VA National SUD office to implement SUD care quality improvements.

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DRA: Substance Use Disorders, Health Systems Science

DRE: Engagement Science, Treatment - Policy Outcome Evaluation, Treatment - Comparative Effectiveness

Keywords: None at this time.

MeSH Terms: None at this time.