BACKGROUND/RATIONALE:
VHA cares for almost 3 million Veterans living in rural areas, comprising 32% of all enrollees. Mental health disorders represent one of the greatest sources of disability among Veterans, including rural Veterans. Among OEF/OIF/OND Veterans enrolled in VHA, 57% have been diagnosed with a mental health disorder since 2002. In 2010, 64% of VHA enrollees received primary care services at a CBOC. However, evidence based mental health practices developed for large VA Medical Centers (VAMCs) are often not feasible to deploy in small rural CBOCs, and thus are not accessible to large numbers of rural Veterans. The lack of access to specialty mental health services and the limited capacity of the specialty mental health service line within VHA contribute to poor engagement in care and less than optimal mental health outcomes for rural Veterans. Virtual care technologies can be used to improve access to and engagement in care for rural Veterans, and to leverage scarce mental health resources to increase capacity. By increasing access and capacity, VHA can reach a greater proportion of patients in need and maximize its population level health impact.

OBJECTIVE(S):
Aim 1 - Mentor graduate students, post-doctoral fellows, and junior faculty members in order to cultivate the next generation of researchers with the content and methodological expertise needed to maximize VHA's population health impact on rural Veteran enrollees.

Aim 2 - Provide scientific leadership to our HSR&D Center of Innovation and QUERI Programs, and facilitate collaboration with our university affiliates, clinical programs, and operational partners in order maximize VHA's population health impact on rural Veteran enrollees.

Aim 3 - Conduct policy relevant, clinically actionable, and methodologically rigorous research to maximize VHA's population health impact on rural Veteran enrollees.

METHODS:
Aim 1 - Mentor graduate students, post-doctoral fellows, and junior faculty members in order to cultivate the next generation of researchers with the content and methodological expertise needed to maximize VHA's population health impact on rural Veteran enrollees.

As the Co-Director of the Post Doctoral Fellowship Program at HSR&D CIVCVDC and the Director of the Division of Population Health in the Department of Psychiatry at the University of Washington, I have many opportunities to mentor junior investigators.

Aim 2 - Provide scientific leadership to our HSR&D Center of Innovation and QUERI Programs, and facilitate collaboration with our university affiliates, clinical programs, and operational partners in order maximize VHA's population health impact on rural Veteran enrollees.

Senior COIN Investigator - I am a core investigator in the HSR&D CIVCVDC. I will participate in weekly "works in progress" meetings and provide one-on-one consultations to COIN investigators.

QUERI Program - As PI of the Virtual Specialty Care QUERI Program, I will promote implementation science around the adoption of technology facilitated clinical practices. I will provide oversight for the QUERI Program and the Implementation Core, lead one of the multi-year projects, and provide guidance to the PIs of the other four projects.

Division Director - As the Director of the Division of Population Health in the Department of Psychiatry at the University of Washington, I will oversee pre-award grant submissions and post-award grants, and setting a research agenda for this new Division. I will continue to build and strengthen collaborations between investigators at the Puget Sound Veterans Healthcare System and its academic affiliate, the University of Washington.

Aim 3 - Conduct policy relevant and methodologically rigorous research to maximize VHA's population health impact on rural Veteran enrollees.

In the next five years, I propose to complete my Virtual Specialty Care QUERI Program project to measure the population level effectiveness and cost effectiveness of rolling out a telepsychiatry collaborative care program for PTSD in small rural CBOCs. Our QUERI Program's Implementation Core has developed a novel method for measuring the cost of our implementation activities in preparation for calculating population level cost effectiveness estimates. If this EBP and our implementation strategy are found to be cost effective at the population level, we will conduct a national rollout of this EBP as part of the Office of Rural Health's Promising Practices Program. The Office of Rural Health is currently funding the clinical cost of our QUERI project ($1.8 million) and is committed to a national rollout if our QUERI project is successful.


FINDINGS/RESULTS:
Not yet available.

IMPACT:
Impact Goal - To improve rural Veteran's access to and VHA's capacity to deliver evidence based mental health practices through mentoring, leadership, research, and implementation.

PUBLICATIONS:

Journal Articles

1. Campbell SB, Fortney J, Simpson TL, Jakupcak M, Wagner A. Change in social support while participating in behavioral activation for PTSD. Psychological trauma : theory, research, practice and policy. 2019 Nov 1; 11(8):905-908.
2. Johnson V, Wong E, Lampman M, Curtis I, Fortney J, Kaboli P, Fihn S, Nelson K. Comparing Patient-Centered Medical Home Implementation in Urban and Rural VHA Clinics: Results From the Patient Aligned Care Team Initiative. The Journal of ambulatory care management. 2018 Jan 1; 41(1):47-57.
3. Turvey C, Fortney J. The Use of Telemedicine and Mobile Technology to Promote Population Health and Population Management for Psychiatric Disorders. Current psychiatry reports. 2017 Oct 16; 19(11):88.
4. Bauer AM, Hodsdon S, Hunter S, Choi Y, Bechtel J, Fortney JC. Lessons from the Deployment of the SPIRIT App to Support Collaborative Care for Rural Patients with Complex Psychiatric Conditions. Proceedings of the ... ACM International Conference on Ubiquitous Computing. 2017 Sep 1; 2017:772-780.
5. Fortney JC, Curran GM, Hunt JB, Lu L, Eisenberg D, Valenstein M. Mental Health Treatment Seeking Among Veteran and Civilian Community College Students. Psychiatric services (Washington, D.C.). 2017 Aug 1; 68(8):851-855.

DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: none
Keywords: none
MeSH Terms: none