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2019 HSR&D/QUERI National Conference Abstract

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1129 — Community Reintegration and Rehabilitation Pathways and Transitions following Traumatic Brain Injury

Lead/Presenter: Karen Besterman-Dahan,  Rehabilitation Outcomes Research Section, James A Haley VA, Tampa. FL
All Authors: Besterman-Dahan K (Rehabilitation Outcomes Research Section, James A Haley VA, Tampa. FL), Hahm, B (Rehabilitation Outcomes Research Section, James A Haley VA, Tampa. FL), Lind, J (Rehabilitation Outcomes Research Section, James A Haley VA, Tampa. FL) Melilo, C (Rehabilitation Outcomes Research Section, James A Haley VA, Tampa. FL) Downs, K (Rehabilitation Outcomes Research Section, James A Haley VA, Tampa. FL) Dillahunt-Aspillaga, C (Rehabilitation Outcomes Research Section, James A Haley VA, Tampa. FL) Powell-Cope, G (Rehabilitation Outcomes Research Section, James A Haley VA, Tampa. FL)

Objectives:
Community reintegration (CR) is an important outcome for Veterans and Service Members (V/SMs) after a traumatic brain injury (TBI). The purpose of this study was to understand the experiences of V/SMs with complicated mild, moderate and severe TBI with CR post-discharge from acute rehabilitation care. A secondary analysis examined the pathways study participants took to access VA rehabilitation care, how they transitioned to community-based care and the barriers and benefits to accessing VA care and services post- discharge from acute rehabilitation.

Methods:
This five-year longitudinal ethnographic study used a Community-Based Participatory Research approach, employing mixed methods. Thirty V/SMs with TBI, 13 family caregivers, 11 CR specialists, and 16 stakeholders were interviewed up to four times over 18 months; V/SMs also participated in a survey at each study visit to collect data on CR outcomes and social networks. Data were analyzed using a computer-assisted NCT analysis model; the secondary analysis utilized a focused coding approach to identify themes and participant experiences related to specific questions

Results:
Lack of knowledge about VA benefits among V/SMs, family and community medical facilities complicated pathways to rehabilitation. Military status played a role both in how V/SMs with TBIs entered into acute and transitional rehabilitation and the transitions they experienced post-discharge. Service members took a facilitated, direct and timely route to VA services; after discharge, structured military programs and services enabled progress towards CR goals on an outpatient basis. Veterans took circuitous and untimely pathways to VA rehabilitation, and navigated CR goals on their own once discharged home. V/SMs and families reported receiving education, tools and strategies that facilitated CR and independence at the VA.

Implications:
Despite the DoD and VA offering programs to address CR needs for this population, many V/SMs and caregivers cited difficulties with CR post-discharge from acute and transitional rehabilitation. Improvements in post-discharge outpatient services can better sustain progress towards goals attained in rehabilitation

Impacts:
Qualitative methods provided clinicians and policy makers with an ecological lens for CR that is grounded in the life experiences of V/SMs and families. Improvements in post-rehabilitation outpatient care will support further community reintegration and better health outcomes for V/SMs with TBIs.