4030 — VA Provider Perceptions of the Individualized Rehabilitation and Community Reintegration Plan of Care for Veterans with Traumatic Brain Injury

Lead/Presenter: Katelyn Marchany,  COIN - Bedford/Boston
All Authors: Marchany K (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System), Zogas, A (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System), Charns, M (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System; Boston University School of Public Health, Boston, MA) Pogoda, TK (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System; Boston University School of Public Health, Boston, MA)

Objectives:
To document VA polytrauma/traumatic brain injury (TBI) provider perspectives on the utility of the Individualized Rehabilitation and Community Reintegration (IRCR) Plan of Care. The IRCR plan, which is shared with Veterans, tracks rehabilitation goals and treatment for physical, cognitive, mental health, and vocational problems that may impact community reintegration and is mandated for Veterans with a TBI diagnosis requiring case management and at least one skilled therapy intervention.

Methods:
We conducted interviews with 68 providers at 16 VA Medical Centers (8 Polytrauma Network Sites, 8 Polytrauma Support Clinic Teams). We reviewed administrative data to characterize Veterans at these 16 sites who completed a comprehensive TBI evaluation (CTBIE).

Results:
Across these 16 sites, 16,130 Veterans had completed a CTBIE between 07/01/2009 and 09/30/2013. Based on complete data, 12,458 Veterans were categorized as experiencing deployment-related mild TBI (68.7%), moderate/severe TBI (7.8%), or no TBI (23.6%). In the CTBIE, per Veteran, there was a range of 0 to 12 consults indicated for follow-up, with the majority consisting of 1 (23.3%), 2 (20.4%), or 3 (14.5%) consults. Qualitative analysis of interviews found that providers perceived the IRCR plan to facilitate continuity of care, improve communication between providers, establish a central document allowing providers to track Veterans' care and progress, and can be adapted to fit Veteran needs. However, providers also expressed concerns that: the IRCR plan template is not patient friendly (i.e. use of medical jargon) and can be difficult to use, is mismatched to some Veteran's needs (i.e. more suited towards inpatient care), becomes an administrative burden on providers, and does not always facilitate coordination between providers.

Implications:
While most providers found the IRCR plan to be a helpful tool, many reported that it had limitations. Providers suggested improvements, including: changing template language to have less medical terminology, increasing template space to individualize the IRCR plan for each Veteran, eliminating redundancies in the plan, and adapting the template to appear better suited for outpatient care.

Impacts:
Findings may help leadership to restructure the IRCR plan template to increase perceived usability. This may facilitate rehabilitation treatment planning and further improve Veteran readjustment.