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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

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National Meeting 2008

1056 — Geographic Access to VHA Rehabilitation Services by OEF/OIF Veterans

Cowper Ripley DC (Gainesville Research Enhancement Award Program (REAP)), Reker DM (Kansas City VAMC), Vogel WB (Gainesville REAP), Hayes MJ (Kansas City VAMC), Beyth RJ (Gainesville REAP), Litt E (Gainesville REAP), Dewald L (Gainesville REAP), Wang X (Gainesville REAP), Wu SS (Gainesville REAP)

Objectives:
To identify geographic areas (1) where the need for VHA rehabilitation services is greatest, and (2) where there are potential access gaps for such services for OEF/OIF veterans using VHA services.

Methods:
The design was a retrospective, observational, cross-sectional study of OEF/OIF veterans who accessed the VHA during FY-03 and FY-04 and who were identified, based on their ICD-9 codes, as potential candidates for rehabilitation. Specific groups of interest were veterans with traumatic brain dysfunction, traumatic spinal cord dysfunction, traumatic amputation, vision impairment, hearing loss, orthopedic disorders, and burns. Geographic Information System (GIS) tools were used to map the location of returning war fighters in relation to available VHA rehabilitation services and identify potential gaps. Gaps were identified by numbers of veterans outside of reasonable drive times to rehabilitation services.

Results:
We identified 7,842 OEF/OIF individuals with traumatic injury. The VHA Polytrauma System of Care provided acceptable access to 77.9% of inpatients and 76.3% of outpatients in our FY03-FY04 cohorts. Median distance to Level 1, Level 2, and Level 3 polytrauma centers was 411, 121, and 64 miles respectively. Four counties in Alabama (Marion, Lamar, Madison, and Mobile) and 1 county in each of the following states: Nevada (Clark), North Dakota (Ward), Texas (El Paso), Hawaii (Honolulu), Alaska (Anchorage), and Mississippi (Jackson) were identified as areas with potential rehabilitation access gaps.

Implications:
Rehabilitation services are important in the VA today given that OEF/OIF veterans are returning with traumatic and/or polytrauma injury. Despite this importance, access to specialized rehabilitation services has been shrinking. Given the value of these services and the dramatic reduction in the number of specialized rehabilitation units, it becomes important to locate rehabilitation resources 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 by filling service gaps and addressing unmet need.

Impacts:
Research using GIS tools provides a piece of valuable information to decision-makers and planners regarding potential access gaps. Locating services where they are most needed improves access to appropriate care, and, ultimately, improves patient outcomes.


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