# Identifying Modifiable Factors that Affect Veterans At-Risk due to Social Determinants of Health and Psychological Distress Access to Care Within Integrated Primary Care Settings

> **NIH VA I01** · SYRACUSE VA  MEDICAL CENTER · 2022 · —

## Abstract

Background: Veterans are more likely to report psychological distress, which also elevates their risk for
certain social determinants of health, such as unmet social needs (e.g., housing instability). As the entry point
for most Veterans into care, the presence of multidisciplinary members on integrated Patient Aligned Care
Teams (PACTs) in primary care, such as social workers and Primary Care Mental Health Integration (PCMHI)
providers helps to address the wholistic needs of these Veterans by providing increased access to additional
resources that have found to improve patient outcomes. Significance: However, prior research has showed
that these integrated PACTs continue to demonstrate significant variation in meeting the needs of Veterans
with psychological distress and unmet social needs (even with the skillsets brought to the PACT by the new
members) leaving opportunities to improve access. Due to the negative impact of the comorbid experience of
psychological distress and unmet social needs on Veteran’s health on health, identifying ways to optimize
access to care within these integrated PACTs is an opportunity to reach a broad array of Veterans. Innovation
and Impact: The proposed research is innovative through its attention to an underdeveloped area of the
healthcare structure, integrated PACT characteristics, and its relationship with access. Informed by prior PACT
implementation literature and a conceptual framework on patient navigation, integrated PACT characteristics
include: structural, provider-specific, and team behaviors. Our aims seek to use mixed methods to provide
a comprehensive understanding from multiple perspectives on PACT characteristics predictive of improved
access and identify associated processes to achieve access within integrated PACTs within this high need
population. These results will provide immediate guidance to VHA on the types of evidence-based
interventions that can be utilized and practice changes that may support those interventions in achieving
access to care for Veterans with unmet social needs and psychological distress. Specific Aims: Aim 1 will
identify integrated PACT characteristics (provider, structural, and team behaviors) that significantly
predict initial engagement to care among Veterans with unmet social needs and psychological
distress. Hypothesis: Integrated PACT structural, such as staffing, and team behaviors, such as team meetings
will be the strongest predictors of initial Veteran engagement in care. Aim 2 will identify best practices and
perspectives from members and administrators within high performing integrated PACTs on ways to achieve
optimization of significant integrated PACT characteristics supporting high levels of engagement among these
Veterans. Aim 3 will test a model of hypothesized relationships between integrated PACT characteris tics and
access as measured by Veterans’ perceptions of care (perceived access), ratings of quality of care, and
engagement in care. Methodology...

## Key facts

- **NIH application ID:** 10452919
- **Project number:** 1I01HX003450-01A1
- **Recipient organization:** SYRACUSE VA  MEDICAL CENTER
- **Principal Investigator:** Jennifer S Funderburk
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-06-01 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10452919

## Citation

> US National Institutes of Health, RePORTER application 10452919, Identifying Modifiable Factors that Affect Veterans At-Risk due to Social Determinants of Health and Psychological Distress Access to Care Within Integrated Primary Care Settings (1I01HX003450-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10452919. Licensed CC0.

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