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2019 HSR&D/QUERI National Conference Abstract

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1059 — Outpatient Polytrauma/TBI Teams that Integrate Vocational Rehabilitation Staff have Better Veteran Employment Outcomes

Lead/Presenter: Terri Pogoda,  COIN - Bedford/Boston
All Authors: Pogoda TK (Center for Healthcare Organization and Implementation Research, Boston University School of Public Health), Marchany K (Center for Healthcare Organization and Implementation Research), Stolzmann KL (Center for Healthcare Organization and Implementation Research) Iverson KM (Women's Health Sciences Division, National Center for PTSD, Center for Healthcare Organization and Implementation Research, Boston University) Zogas A (Center for Healthcare Organization and Implementation Research) Sayer NA (Center for Care Delivery and Outcomes Research, University of Minnesota Charns MP (Center for Healthcare Organization and Implementation Research, Boston University School of Public Health)

Objectives:
To examine whether integration of Polytrauma/traumatic brain injury (TBI) teams and Vocational Rehabilitation (VR) staff is associated with better employment outcomes for Veterans evaluated for TBI.

Methods:
This mixed-methods study integrated VA administrative data from 16 outpatient Polytrauma/TBI clinics, with comprehensive TBI evaluation (CTBIE; baseline) and survey data (3-year follow-up) from patients (N = 702) seen in these clinics. The primary outcome was Veteran employment status. We also interviewed VA clinicians (n = 68) at the time of survey to determine whether VR staff was integrated with the Polytrauma/TBI team and the nature of Polytrauma/TBI team and VR staff interactions.

Results:
Employment status did not differ across sites at time of CTBIE (p = .570). At 3-year survey follow-up, when controlling for patient factors, compared to sites with no Polytrauma/TBI team-VR integration (n = 7), sites with Polytrauma/TBI team-VR integration (n = 9) had higher percentages of Veterans who were employed/students (64.2% vs. 58.1%) or unemployed/looking for work (12.9% vs. 7.8%), and lower percentage of Veterans who were unemployed/not looking for work (22.8% vs. 34.1%), p = .001. Interview data with providers at sites with Polytrauma/TBI team-VR integration indicated that Polytrauma/TBI teams learn about vocational goals and timelines from VR staff as they address physical and psychological health conditions, and VR staff learn about Veteran strengths and limitations from the Polytrauma/TBI team when doing job development. Polytrauma/TBI teams valued VR staff input since they observed Veteran function in the community, allowing for a broader picture of how Veterans perform outside of a clinical setting. Including VR staff at polytrauma/TBI clinic meetings facilitated relationship-building and overall communication.

Implications:
Integration between Polytrauma/TBI teams and VR staff is associated with better employment outcomes for Veterans who were evaluated for TBI.

Impacts:
Polytrauma/TBI teams that include VR staff allows for better interdisciplinary team communication to identify and address Veteran physical, psychological, and occupational needs. In turn, this is associated with increased employment and job seeking. Dedicating resources for VR staff to be integrated with Polytrauma/TBI teams can help Veterans meet employment goals. Employment is an important dimension of Veteran health care which may have long-term benefits.