Background: The purpose of this study is to inform strategies to improve screening and treatment processes for Veterans returning from deployment. For almost a decade the Veterans' Health Administration (VHA) has been screening post 9-11 Veterans for traumatic brain injury (TBI) and other deployment-related invisible injuries. Despite the time and resources invested, little is known about outcomes of these screening programs. This project will provide crucial information for improving the current screening program and implementing a new program in the event of future wars. This study will be the first to systematically evaluate outcomes associated with the VHA's TBI post-deployment screening processes and integrate findings from TBI screening with findings from mental health (MH) screening. Project Objectives: (1) Describe specialty care treatment patterns following TBI screening; (2) Determine if the TBI screening process results in different patterns of specialty care utilization compared to just MH screening; and (3) Determine whether post deployment TBI screening enhances clinical outcomes and quality of life. Project Methods: This study will involve: (1) a retrospective analysis of VHA national post deployment screening and utilization data as well as (2) a survey of a subset of those individuals identified in the national data as having been screened for TBI. VHA national data will be utilized to examine the screening and evaluation results (both TBI and MH), as well as subsequent treatments received, by category. DSS identifiers will be used to create categories of outpatient services: MH, Neurology, and Physical Medicine and Rehabilitation (PMR). Data from Corporate Data Warehouse inpatient and outpatient data domains will be used to obtain diagnoses, categorize the inpatient and outpatient health services utilization (including medications) based on the category of care (i.e., Neurology, MH, PMR). In addition to VA national data, we will survey a random sample of the individuals identified as having been screened for TBI during the study period. We will mail questionnaires to this sample to evaluate outcomes and potential moderators/mediators of outcome, controlling for relevant variables. Priority Area: This project is relevant to HSR&D's priority on healthcare system change, as factors associated with efficiency and outcome with be investigated. This project also aligns with HSR&D's focus on postdeployment health (Atkins et al., 2017); existing data will be leveraged to evaluate services and outcomes associated with postdeployment screening. Expected Results/Significance: This study will be the first to systematically evaluate outcomes associated with the VHA's TBI post-deployment screening processes and integrate findings from TBI screening with findings from MH screening. VHA has invested heavily in post deployment screening. Despite increasing identification of possible TBI, it is unknown if the TBI screen and subsequent treatments improve outcomes over and above the MH screening process in place before the TBI screening. The significant overlap between TBI and MH symptoms may create inefficiencies, redundancies, and ?silo? approaches to treatment following positive screens. As such, data on the `value added' of the TBI screen will be important for enhanced efficiency, greater access to care via reduction of waste, scientific evidence on long-term outcomes of post deployment screening.
This study will be the first to prospectively evaluate health outcomes associated with the Veterans Health Administration's (VHA) traumatic brain injury (TBI) postdeployment screening. It will also evaluate the extent of overlap in services rendered as a result of concurrent TBI and mental screening. The information obtained will be the necessary first step to inform clinical strategies and operations policy to improve quality, coordination, and efficiency of screening, evaluation, and treatment processes and healthcare outcomes for Veterans returning from deployment.
