# Understanding Pathways to Care for Veterans who Screen Positive for PTSD: The PTSD Access To Healthcare (PATH) Study

> **NIH VA I01** · VA BOSTON HEALTH CARE SYSTEM · 2024 · —

## Abstract

Background: Nearly half of Veterans who screen positive for PTSD in VA primary care clinics do not receive
VA mental health treatment. To increase timely access to VA care, we must understand Veterans’ access
pathways (the series of options offered to, and choices made by, Veterans after a positive PTSD screen that
may lead them to VA care). Mapping these pathways is key to understanding who is being lost to VA care and
where they are being lost. Further, by examining contextual and individual factors that predict who and where
Veterans are falling off these pathways, we will be able to ascertain why these Veterans are being lost.
Significance: The proposed IIR is responsive to the HSR&D priorities of both mental health and access to
care and will provide insight into the impact of the MISSION Act on mental health access. At the completion of
this project, we will provide three distinct deliverables: 1) guidance on where and to whom access interventions
should be targeted; 2) policy and practice guidance to aid providers in linking Veterans who screen positive to
effective VA care; and 3) a method for classifying Veterans from screening to VA mental health care, which
could be extended to other conditions (e.g. suicidality).
Innovation and Impact: Past research designed to provide information to improve access to PTSD care has
been limited by focusing on the end goal (whether these Veterans do or do not access care) rather than the
process by which Veterans arrive at this goal (the access pathways). The proposed project is not only one of
the first to consider access to care as a process rather than an end point, it is the only study to propose
examining the process of access comprehensively using a method that will generalize to the VA system as a
whole, and will be applicable to other healthcare conditions identified by VA-based screening.
Specific Aims: The proposed mixed methods study has the following aims:
1. Aim 1: Identify contextual- and individual-level variables that differentiate Veterans classified into a VA initial
 access step (an immediate response to a positive PTSD screen in primary care likely to lead to VA care;
 e.g., referral to PC-MHI) from those who were not, including those referred to community care via the
 MISSION Act.
2. Aim 2: Understand VA providers’ and patients’ experiences with, and perspectives on, why Veterans are lost
 to VA follow-up care immediately after screening positive for PTSD, including the role of the MISSION Act.
3. Aim 3: Map the access pathway steps hypothesized to follow each of the six initial VA access steps, as well
 as the step hypothesized to lead to community care provided via the MISSION Act, by leveraging the
 methods developed in our pilot work.
Methodology: Aim 1 will include all Veterans with new PTSD screens in primary care between FY 2017-2019.
Data from the VA Corporate Data Warehouse (CDW) will be used to determine Veteran access step
classification and to identify contextual and i...

## Key facts

- **NIH application ID:** 10731732
- **Project number:** 5I01HX003297-03
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** Michelle Bovin
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-10-01 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10731732

## Citation

> US National Institutes of Health, RePORTER application 10731732, Understanding Pathways to Care for Veterans who Screen Positive for PTSD: The PTSD Access To Healthcare (PATH) Study (5I01HX003297-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10731732. Licensed CC0.

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