Access to mental health (MH) care continues to be a challenging issue for VHA. There is some recent concern that the VA needs to develop access measures that more accurately reflect the patient experience of accessing mental health care. This is especially important with the increased use of digital technology to deliver health care interventions at a distance. In order to better understand this problem we will talk directly with VA patients in an open-ended way about their experience accessing mental health services. We will use this information to develop a patient-centered survey to measure perceived access to mental health services. We will then test the validity and reliability of this measure. The final version of the PAI from this study wil then be available for use by our partners in VA Central Office and other researchers.
Access to mental health (MH) care continues to be a challenging issue for VHA. A VA State-of-the-Art Conference(SOTA)inSeptember2010onthetopicof'ImprovingAcestoVACare'adresesarecent recommendation from the VA Office of the Inspector General that the VA develop access measures that more accurately reflect the patient experience of accessing mental health care. According to the SOTA framework, access to care includes the potential ease of having virtual or face-to-face encounters with a broad array of healthcare providers including clinicians, caregivers, peers, and computer applications. To our knowledge, none of the available access measures encompasses all five of the conceptual domains identified in the new SOTA Access framework (i.e., geographical, temporal, financial, cultural and digital). 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. The goal of this proposal is to deliver on this recommendation. In order to address this problem, we will use a mixed-methods approach to better understand the complex issues associated with measuring perceived access from the patient perspective, particularly as it relates to the new intersection of perceived access and e-health technologies. The overall objective of this proposal is to generate a psychometrically sound patient-centered measure of Veterans' perceived access to MH treatments. We will accomplish this by (1) collecting qualitative 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 60-90 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 (and hopefully to patients recruited to participate in other studies that are part of this CREATE application) to evaluate the validity and reliability of this measure and perform analyses for potential item reduction. The final version of the PAI from this study will then be available for use by our partners in VA Central Office and other researchers.
