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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3016 — Rates and Predictors of Readmission after Discharge from a PTSD Residential Treatment Program in the VA System

Cohen MB (Yale School of Public Health), Pilver CE (Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, Yale School of Medicine), Desai MM ( Yale School of Public Health, RWJ Clinical Scholars Program, Yale School of Medicine), Desai RA (Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, Yale School of Public Health)

Objectives:
The prevalence of Post Traumatic Stress Disorder (PTSD) within the Veterans Administration (VA) is increasing with the return of military personnel from Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]). As an alternative to inpatient treatment, many veterans enroll in VA PTSD residential rehabilitation treatment programs (RRTPs). Due to the lack of information about RRTPs, the primary objective of the present study was to determine the rate and predictors of readmission 1 year after discharge from a VA RRTP for PTSD. In addition, we sought to determine whether veterans returning from OEF/OIF differ from other veterans at admission to these programs.

Methods:
We utilized VA administrative data collected from FY 2004-2008 from 40 VA sites with RRTPs. Generalized estimating equations were used to account for the clustering of patients within programs.

Results:
15,205 veterans were admitted to PTSD RRTPs throughout the country, 17.7% of whom were readmitted within one year of discharge. Younger age, severity of PTSD symptoms, participation in the wars in Afghanistan and Iraq, and alcohol abuse/dependence significantly increased the likelihood of readmission, while having a stable living situation and a paying job at discharge decreased the likelihood of readmission. OEF/OIF veterans were significantly younger, more likely to have an axis I disorder, and more likely to have had previous psychiatric treatment when compared to other veterans; additionally, they were more likely to be readmitted.

Implications:
These data indicate that the VA needs to be prepared to treat veterans with mental illness as they return from the Middle East. Moreover, there are factors associated with the likelihood of subsequent psychiatric admissions that can be addressed in RRTP setting.

Impacts:
Rates of readmission after discharge from a PTSD RRTP are high. This study identified factors that significantly impact the likelihood of readmission. These findings should be used to tailor programs and discharge conditions to increase the chances that treatment will be successful. Additionally, veterans of OEF/OIF have significantly higher rates of readmission compared to other veterans. It is crucial that services aimed at treating PTSD are available and successful at treating returning soldiers.


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