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IIR 16-230 – HSR&D Study

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IIR 16-230
Recommendations and Interventions for and Changes in the Ocular Health and visual Function of Veterans with Traumatic Brain Injury
Steven G. Scott DO MS BS
James A. Haley Veterans' Hospital, Tampa, FL
Tampa, FL
Funding Period: April 2018 - March 2021

BACKGROUND/RATIONALE:
More than 65% of patients traumatic brain injuries report vision problems. Traumatic brain injury (TBI) can damage not only the eye, but the visual (sensory and ocular-motor) pathways and/or cortical processing areas. Thus, the traditional objectives and treatment plans for eye-related blindness or low-vision may not be appropriate for combat and TBI related vision injuries. In 2008, the Veteran Health Administration (VHA) performed evaluations on patients with a diagnosis of TBI admitted to VHA Polytrauma Rehabilitation Centers. Our study is the first known study to investigate this service delivery data.

OBJECTIVE(S):
The project objectives are to: (1) evaluate access to and utilization of vision health care services for VHA patients with TBI. The Specific Aims are to (2) describe rehabilitation service delivery; and (3) explore clinical recovery as measured by visual and ocular outcomes.

METHODS:
This is a population-based study of all patients with TBI admitted to VHA Polytrauma Rehabilitation Centers since 2008. Both retrospective large data and prospective survey designs will be used. Retrospective data will be extracted from the Corporate Data Warehouse. Natural language processing will be used to extract data from clinical notes. An expert panel will validate extracted data. Geographic Information System tools will be used to evaluate geographic barriers. The final dataset will consist of patient characteristics, treatment recommendations, access factors, facility locations, clinic visits, treatments/assistive devices, and patient-level outcomes. Frequentist and Bayesian Network methods will be used to analyze data.

FINDINGS/RESULTS:
None to date.

IMPACT:
The impact of this study on Veterans and the VHA system of care will be the development of recommendations to improve access to and utilization of quality TBI-related vision services. This will be accomplished by translating PRC specialized knowledge to non-specialized VHA facilities closer to the patients' residences.

PUBLICATIONS:
None at this time.


DRA: Aging, Older Veterans' Health and Care, Acute and Combat-Related Injury, Brain and Spinal Cord Injuries and Disorders
DRE: Diagnosis, Treatment - Comparative Effectiveness, TRL - Development
Keywords: Outcomes - Patient
MeSH Terms: none