# Quality of Care for Justice-Involved Veterans: Gaps, Predictors, and Stakeholder-Driven Solutions

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2020 · —

## Abstract

Background: Justice-involved Veterans – military Veterans detained by or under the
supervision of the criminal justice system – have an excess burden of mental health and
medical morbidity, as well as elevated mortality risk compared to the general and
Veteran populations. Despite high rates of use of mental health and substance use
disorder treatment, justice-involved Veterans are at risk for receiving lower quality
mental health and addiction treatment. Furthermore, the quality of their medical care
has never been examined despite their heightened risk for disparities. By examining
patterns in quality of care, identifying patient, provider, and health system factors related
to high and low quality of care, and hearing from justice-involved Veterans and VA staff
about barriers to and facilitators of high quality care, we can develop new quality
improvement initiatives to improve care for this vulnerable population.
Objectives: Specific aims are to: (1) Determine whether justice-involvement is an
independent risk factor for poor care quality; (2) Identify predictors of care quality
among justice-involved Veterans; and (3) Evaluate Veterans' and other stakeholders'
perceptions of factors that explain variation in quality of care.
Methods: The proposal project is guided by the Behavioral Model for Vulnerable
Populations. Aim 1 uses existing VHA administrative databases and established
process quality measures to examine whether being justice-involved is independently
associated with lower quality of care. We will focus on major causes of morbidity and
mortality in this population, including substance use disorders, mental health disorders,
hypertension, hepatitis C, HIV, and colorectal cancer. Aim 2 uses existing VHA
administrative databases to identify predictors of high or low quality of care among
justice-involved Veterans. Secondary analyses will examine a subset of Veterans who
have more detailed data collected during justice outreach. In Aim 3, we will conduct 80
qualitative interviews total with justice-involved Veterans and VHA justice outreach staff,
clinicians, and managers. The Consolidated Framework for Implementation Research
will guide qualitative data collection, coding and analysis.
Summary: This study will serve as the foundation for future studies that address
barriers to and implement drivers of high quality care across VHA facilities.
Accomplishing these aims will help us understand and improve the quality of care
received by some of our most vulnerable Veterans, improve their health, and decrease
their risks for hospitalizations and mortality.

## Key facts

- **NIH application ID:** 9702654
- **Project number:** 5I01HX002366-02
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** Andrea K Finlay
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-05-01 → 2021-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9702654

## Citation

> US National Institutes of Health, RePORTER application 9702654, Quality of Care for Justice-Involved Veterans: Gaps, Predictors, and Stakeholder-Driven Solutions (5I01HX002366-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9702654. Licensed CC0.

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