3031 — The VA's TBI Clinical Reminder Screen and Evaluation - Practice Patterns
Belanger HG, Tampa VA; Univ of South Florida; Center of Innovation on Disability and Rehabilitation Research (CINDRR); North Florida/South Georgia and Tampa; Spehar A, Center of Innovation on Disability and Rehabilitation Research (CINDRR); North Florida/South Georgia and Tampa; Klanchar A, Center of Innovation on Disability and Rehabilitation Research (CINDRR); North Florida/South Georgia and Tampa; Powell-Cope G, Center of Innovation on Disability and Rehabilitation Research (CINDRR); North Florida/South Georgia and Tampa;
To ensure that deployment-related problems do not go unidentified/untreated, the Veterans Health Administration (VHA) developed screening processes specifically for Operations Iraqi Freedom, Enduring Freedom, and New Dawn veterans. The objective of this study is to describe practice patterns associated with the VA TBI Screen and Comprehensive Evaluation and determine whether they vary by patient or provider characteristics.
Data from 614 OEF/OIF veterans (from 21 different VA facilities) who had initial healthcare visits between October 1, 2008 and March 31, 2011 and who had completed the VHA's Comprehensive TBI Evaluation (CTBIE) were drawn from national data. Chart reviews were conducted on these individuals to code screening and CTBIE-associated events and characteristics. Logistic regression models were used to determine if screeing/evaluation timeliness was related to patient or facility characteristics.
Veterans were primarily male (95%), never married (59%) with a mean age of 29.8. The majority of individuals (57.8%) discussed more than one injurious event during the CTBIE, though ultimately, the majority of patients were either not diagnosed with TBI (34.4%) or were diagnosed with one TBI (28.7%) by the CTBIE provider. Teams performed CTBIEs (52.1%) about as often as individuals (47.9%). On average, 28.8 days passed between the first health care visit and screening (although 75% were seen within one day), and an average of 44.3 days between screening and CTBIE (although 66% were evaluated within 30 days of screening). Patient characteristics (gender, age, race, education, employment status, marital status) were not significantly related to the time between initial healthcare visit and screening, nor was level of care (i.e., Polytrauma Center, Polytrauma Network Site, etc). Having an evaluation completed within 30 days was less likely in minority patients (p < .005). No other patient or facility characteristics were associated with having an evaluation within 30 days.
The vast majority of patients are screened for TBI during their initial healthcare visit. Comprehensive TBI evaluations are conducted using team and individual approaches at similar frequencies. Generally, patient and facility characteristics were not associated with timeliness.
These findings have implications for VHA policy makers in Physical Medicine and Rehabilitation.