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DHI 05-264 – HSR&D Study

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DHI 05-264
Treatment and Costs of Blast Related Injuries in VA
Kris Siddharthan PhD MS
James A. Haley Veterans' Hospital, Tampa, FL
Tampa, FL
Funding Period: January 2006 - September 2008

BACKGROUND/RATIONALE:
Polytrauma/Blast-related injuries (PT/BRI) are the most frequent cause of combat-related trauma, and represent a high priority, high cost area for the VA. Immediate complications from blasts encountered in battle can be characterized as blunt trauma to the brain, head, spine, torso and extremities, complications of gas filled organs, burns, fractures, hearing and vision loss. To date there is no established model for providing blast injury medical care.

OBJECTIVE(S):
The immediate goal of this study is to more fully understand the range and patterns of clinical complications associated with blast injuries sustained in Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF), necessary to provide timely and appropriate care. The objectives for this two-year descriptive study are to:

1.Characterize the diagnoses, treatments, and clinical complications associated with initial VA hospitalization for persons with blast injuries, using data from FY03-06.
2.Investigate health care utilization and costs associated with VA inpatient and outpatient services for individuals with blast-related complications for the first 18 months after presenting to the VA medical center.

METHODS:
Quantitative and qualitative methods will be used to research objectives. For objectives 1 and 2, the sample will include all OIF/OEF veterans with blast related injuries presenting to the James A Haley VAMC at Tampa, Fl between 2003 and the early part of 2007. Chart reviews using the Veterans' Health Information Systems & Technology Architecture (VistA) and data collection protocols developed at the PT/BRI Center at the Tampa VA will be used to address Objective 1. VA administrative data such as the Medical SAS Inpatient and Outpatient Datasets, and Decision Support System (DSS) will be used to capture healthcare utilization and costs (Objective 2).

FINDINGS/RESULTS:

Two major findings have evolved from our research 1) Aggressive rehabilitation at initial hospitalization in a VA facility results in better health care outcomes at discharge as measured by standard instruments such as the FIM and results in lower cost in subsequent treatments at VA facilities and 2) the high consumption of central nervous system (CNS) and musculoskeletal (MS) medications for treatment of pain and depression suggest the need for close monitoring for drug addiction and adverse side effects. Our preliminary findings are contained in poster presentations at HSR&D's 25th and 26th National Meetings and in published manuscripts in the VA Journal of Rehabilitation and Research Development (JRRD), Journal of Rehabilitation Nursing and Military Medicine.


IMPACT:
Information gained and associated research findings will be valuable to the 4 designated VHA Polytrauma Centers for determining taxonomy of PT/BRI. Findings are currently aiding clinical care givers at the James Haley Veterans Hospital in Tampa, Fl in designing clinical pathways for treatment of blast related injuries.

PUBLICATIONS:
None at this time.


DRA: Acute and Combat-Related Injury, Military and Environmental Exposures
DRE: Treatment - Observational
Keywords: Operation Iraqi Freedom, PTSD, Spinal cord injury
MeSH Terms: none

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