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RRP 07-334 – HSR&D Study

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RRP 07-334
Transition from TBI Screen to Full Assessment: Barriers & Facilitators
Gudrun Lange PhD
East Orange Campus of the VA New Jersey Health Care System, East Orange, NJ
East Orange, NJ
Funding Period: June 2008 - April 2009

BACKGROUND/RATIONALE:
TBI is an important concern among returning OIF/OEF Veterans with prevalence estimates in the 10-28% range (Okie, NEJM, 2005). The VA has implemented a TBI clinical reminder screening protocol (Perlin, IL 10-2006-004) to ensure the identification and full evaluation of Veterans at high risk of having TBI. Intrinsic to TBI, however, are symptoms that may present barriers to successful transition from screening to evaluation and treatment. These include attention, concentration and memory deficits, impaired awareness of problems, and behavioral manifestations such as apathy, dependency, slowness and passivity (French, 2006). Further complicating TBI care are overlapping combat stress reactions that can include anxiety, depression and emotional lability as well as somatic symptoms such as sleep disturbances, fatigue, dizziness, and headache. These symptoms may disrupt the hand off from screening to 2nd level TBI evaluation and treatment compromising the effectiveness of the TBI clinical reminder.

OBJECTIVE(S):
The specific objectives of the proposed pilot study were:
1. To synthesize patient perceptions of barriers and facilitators to 2nd level TBI assessments following a positive TBI screen using the VA clinical reminder; 2. To identify patient characteristics that are risk factors for failing to transition from positive TBI screen to full assessment; and 3. To examine the association between gender and other patient factors that affect TBI screening in OIF/OEF Veterans.

METHODS:
Fifteen OEF/OIF Veterans who a) screened positive for TBI using the clinical reminder, and b) were referred for the 2nd level evaluation of TBI were given a semi-structured interview to evaluate the process of transitioning from TBI screen to 2nd level evaluation. Veterans were identified by clinician investigators and asked to participate in the study. Participant consent and interviews were audio recorded. Scripted questions with ad hoc follow up questions were used to assess barriers, facilitators and other factors associated with TBI evaluation. Chart review was conducted to complete clinical and demographic information about participants.

FINDINGS/RESULTS:
Participants identified difficulties with care coordination and scheduling of appointments as primary barriers to care. In addition, Veterans expressed confusion regarding their initial TBI screening and the process of higher level assessment. Structural supports such as reminder phone calls were cited as being very helpful.

IMPACT:
By identifying the perceived barriers to TBI evaluation following a positive screen, the VA may be able to improve health service delivery through streamlining communication and scheduling with Veterans.

PUBLICATIONS:
None at this time.


DRA: Military and Environmental Exposures
DRE: Diagnosis, Treatment - Observational
Keywords: Traumatic Brain Injury
MeSH Terms: none

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