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GEOGRAPHIC ACCESS TO VHA REHABILITATION SERVICES FOR OEF/OIF VETERANS
Project Number DHI 06-010 funded
by HSR&D.
October 1, 2006 -
September 30, 2007
With the change in modern warfare and military operations, the injuries sustained by today’s soldiers are different from past military engagements. Injuries that probably would have resulted in death in earlier combat engagements are today not as lethal due to advances in military protective gear worn by the troops. As a result of greater survival, however, the returning OEF/OIF veterans may have a greater need for rehabilitation due to residual deficits from traumatic injury, or polytrauma injury, than any other period of service veterans preceding them. Unfortunately, very little is known about access to rehabilitation services, the rehabilitation needs or patient outcomes of OEF/OIF veterans who sustained injuries while on active duty.
(1) To identify a cohort of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) combat veterans who accessed Veterans Health Administration (VHA) facilities for conditions and injuries sustained while on active duty, merge the identified cohort with VHA workload data sets to obtain socio-demographics, medical diagnoses, and utilization information on these individuals, and to identify a subgroup of veterans who are potential candidates for physical medicine and rehabilitation services; (2) To use Geographic Information System (GIS) tools to ascertain veterans’ access to differing levels of VHA rehabilitation and medical services offered to veterans with potential need for rehabilitation services; and (3) To investigate the health services utilization, especially the receipt of both inpatient and outpatient rehabilitation services, provided to these veterans for a one year follow-up period.
The design is a retrospective, observational, cross-sectional study of a subgroup of OEF/OIF veterans who accessed the VA health care system during FY-03 and FY-04 and who are identified, based on their ICD-9 codes, as potential candidates for rehabilitation. Major characteristics: The specific groups of interest in this study are veterans who have ICD-9 codes that are associated with traumatic brain dysfunction, traumatic spinal cord dysfunction, traumatic amputation, vision impairment, orthopedic disorders, and burns. Based on preliminary data, we expect to find between 8,000 and 10,000 individuals in these diagnostic categories. Only veterans who received services in VHA are included. Major variables and source(s) of data: VA facility characteristics (i.e., level of care), patient characteristics (predisposing, enabling and need), and travel distance/travel time to the VA facility are the major variables. All information will be obtained from extant VA data sources. Main types of analysis: The analysis plan for this study is divided into two phases. The first phase employs GIS tools to map the location of returning war fighters in relation to where VHA rehabilitation services are available and identifies potential gaps in services (Objectives 1 and 2). The second phase will use a two-part model (logistic regression and poisson regression) to estimate (1) the receipt of any specialized rehabilitation services; (2) the volume of VHA rehabilitation service use (Objective 3).
No results at this time.
Start-up activities.
Rehabilitation services are especially important in the VA today given that OEF/OIF veterans are returning with service-connected traumatic brain dysfunction, traumatic spinal cord dysfunction, traumatic amputation, vision impairment, orthopedic disorders, burns and/or polytrauma injury. Despite this importance, access to specialized rehabilitation services in the VA has been shrinking. Given the value of these services and the dramatic reduction in the number of specialized rehabilitation units in the VA, it becomes critically important that the remaining VA rehabilitation resources are located where there is the greatest need for such services. If new resources are added for rehabilitation services, it is equally important to locate them where they will provide the largest impact in terms of filling service gaps and unmet need.
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