Care of our new OEF/OIF veterans is a priority for VA. The transition process from Department of Defense (DOD) to VA care has been little studied but is an urgent concern for critically wounded personnel from the ongoing Global War on Terror (OEF/OIF). Patient care data flow from DOD to VA electronic medical records has not been established, although summary DOD care information is being tested at 4 VA rehabilitation facilities. Thus, developing personal relationships between researchers at VA and DOD is essential to researching transition between the systems.
The primary objectives were to establish the feasibility of DOD-to-VA PHI transfer on a local level, and to assess the rate of transition to VA from Brooke Army Medical Center (BAMC) for the cohort of BAMC patients seen during FY02-FY07. We characterized types and timing of care subsequently received in the VA, and looked at treatment retention in VA for at-risk subgroups, focusing on mental health care. Study results will help inform research and care-planning for seriously wounded OEF/OIF veterans who are entering the VA system now or will enter in the near future.
The study was approved by our VA IRB prior to funding. Working with collaborators at Brooke Army Medical Center, we obtained IRB approval from the DOD IRB at BAMC, and transferred patient identifiers from BAMC to our VA facility via hand-carried encrypted media. Subsequently we matched identifiers to VA administrative databases and extracted dates, types of VA healthcare use, and diagnoses. Quantitative methods included descriptive statistics and covariate-adjusted models of time to transition to VA.
PHI transfer from DOD's Brooke Army Medical Center to the Veterans Health Administration was feasible using personal contacts, although electronic transfer would likely be more efficient and secure. Our cohort included 994 OEF/OIF seriously wounded warriors cared for at and discharged from BAMC during FY02-FY06, of whom 236 (24%) transitioned to the VA and 219 (22%) used VA services. Among transitioned veterans, 40% used VA care within 6 months of a BAMC discharge, and 77% within 1 year; the last came into the VA 39 months post-discharge from BAMC. Two-thirds (67%; 147/219) of these patients accessed VA mental health care services. The proportion of the multi-year cohort using the VA was less than 50% through FY06 and then jumped to 90% in FY07. Nearly half (48%) had at least one psychiatric diagnosis noted in VA data, most commonly depression (30% of 219 persons) or post-traumatic stress disorder (PTSD; 34% of 219); 42% had VA prescriptions for psychotropic agents. Treatment retention in FY07 differed by receipt of psychiatric care in VA: 99% with psychiatric care vs 85% among those not receiving psychiatric care (p<.001).
Our study determined that PHI transmission from a DOD medical treatment facility to VA was feasible and estimated the rate of transition to the VA healthcare system of critically injured OEF/OIF military personnel treated at the Department of Defense (DOD) Brooke Army Medical Center (BAMC). We established a straightforward protocol for the exchange of medical data with BAMC collaborators. Our REAP is uniquely co-located with BAMC in San Antonio, enabling the development of a research agenda with the sole military medical treatment facility charged with care of military burn patients and one of a handful caring for traumatically injured non-burn patients from combat theaters.
- Copeland LA, Zeber JE, Bingham MO, Pugh MJ, Noël PH, Schmacker ER, Lawrence VA. Transition from military to VHA care: psychiatric health services for Iraq/Afghanistan combat-wounded. Journal of affective disorders. 2011 Apr 1; 130(1-2):226-30.
- Copeland LA, Zeber JE, Bingham MO, Pugh MV, Lawrence VA. Transition of Wounded Warriors into VA Care. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 27; Little Rock, AR.