This project will examine implementation of the much debated TBI Clinical Reminder and begin to examine the effects of implementation. We are proposing to examine the TBI Clinical Reminder data that has been collected with VISN 8 to characterize veterans who complete scheduled follow-up evaluations and estimate health care services after a positive screen. The specific goals of this pilot study are to evaluate consistency and timeliness of implementation, patient characteristics associated with "Reminder" completion, subsequent follow-up/treatment adherence, and outcomes associated with such screening and follow-up.
1.Estimate the number of OEF/OIF veterans who screened positive for mild TBI.
2.Estimate the number of OEF/OIF veterans with a mild TBI who reported a spontaneous improvement.
3.Compare characteristics of OEF/OIF veterans who complete the TBI Clinical Reminder screen on the first visit to the VHA, with those who had a delayed screening.
4.Describe levels of adherence to each step outlined in the clinical process.
5.Compare characteristics of OEF/OIF veterans who attend scheduled follow-up evaluation appointments with those who do not.
6.Delineate potential benefits of the TBI Clinical Screening process to OEF/OIF veterans.
A retrospective chart review of OEF/OIF veterans at the James A Haley Tampa VA was completed. To complete this pilot study, VHA VISN Support Services Center was accessed with a report run specific to the Tampa VA. Identification of the SSN was available based on one co-investigator's clearance levels. Once equipped with the SSN, records from the Computerized Patient Record System (CPRS) were accessed and reviewed.
Our study dates include FY07Q3, FY07Q4, FY08Q1 and FY08Q2. Of the 1869 individuals who were flagged for screening, 163 Tampa patients were screened as positive (9%). Of the 163 who were screened as positive, 91% were male, 76% were Caucasian, with a mean age of 34 + 9.4 years. Forty-eight percent had a college education, 39% were employed and 50% were married. The majority (76%) served in the Army, at an enlisted level (91%). A small percent (n=10) reported to be deployed three times. Eighty-eight percent served in operation Iraqi freedom. There were no significant differences in demographic or deployment related characteristics between those who were screened immediately (first visit) compared to those who were not screened immediately. Levels of adherence were examined regarding the follow up TBI evaluation. Seventy five patients (46%) did not have a follow up TBI evaluation. Potential reasons why include that 63% of the 75 did not have follow up consults generated and the remaining 28 patients (37%) did not make it to the appointment. Time from initial screening to TBI follow up was 64.2 + 66.9 days for the 88 patients who completed the TBI follow up evaluation. Of those 88 individuals, 69% made it to their first scheduled appointment, with only 27 missing but ultimately receiving the care needed. There were no statistically significant differences between the individuals who adhered to follow up appointments compared to those who did not. Portions of this work have been accepted for presentation at the 2009 HSR&D conference.
This short term pilot study addresses the HSR&D priority area of 'Post Deployment Health', specifically TBI Screening for OEF/OIF veterans. It should be acknowledged that the percent of those who have screened positive is lower than what we originally expected from anecdotal reports. For Objective 2, it was of interest to obtain the individuals who had spontaneous improvement. At the time of this study, data that is in existence from the Patient Care Services Office of Strategic Planning and Measurement was not available with identifiable SSN, thus that objective was not achieved.
When mild or subtle brain injuries go undetected, impairments in attention, memory and executive functions may occur, impacting post-military adjustment and quality of life. Thus, the long term goal of this line of research is to improve the health and quality of life for OEF/OIF veterans by assessing the value of the TBI Clinical Reminder Screening and subsequent evaluations and treatment. Given the recent media focus on TBI screening in the OEF/OIF veterans, examination of the data collected from this pilot study will enable a description of the population which is being screened and identify the outcomes of those initial screens.
External Links for this Project
Fitzgerald SG. Characteristics of the TBI Clinical Reminder Screening Process. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 1; Washington, DC. [view]