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Predicting Potential Demand for OEF/OIF Rehabilitation Services in the VHA

Vogel WB, Kairalla J, Wang X, Litt ER, Castro JG, Wilson LK, Cowper Ripley DC, Reker DM. Predicting Potential Demand for OEF/OIF Rehabilitation Services in the VHA. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 18; National Harbor, MD.


Objectives: This research seeks to predict the geographic locations with the highest potential demand for VHA rehabilitation services for OEF/OIF Veterans with TBI, SCI, and amputations. The goals are: (1) to produce results that will assist VA planners in deciding which VAMCs are the best candidates for expanded rehabilitation services, and (2) to demonstrate the usefulness of health services research methods in VA strategic planning. Methods: This research combined statistical modeling of the geographic demand for VA rehabilitation services with Geographic Information System (GIS) tools. We used county-level data from the National Patient Care Database (NPCD), the Area Resource File, the American Hospital Association annual survey, and VHA's OEF/OIF and Planning ProClarity Datacubes. We assigned each county in the U.S. to one of 155 VAMC-specific geographic market clusters based on the shortest travel time from the county population centroid. We next estimated statistical models of the number of OEF/OIF Veterans receiving rehab services as a function of OEF/OIF Veteran population, patient travel time to their chosen VAMC, travel time to the nearest VA rehabilitation facility, travel time to the nearest community hospital with rehab services, and various county-level contextual variables (income, poverty, and health insurance coverage). We then modified VAMC travel times to reflect the hypothetical availability of rehab services at the VAMC closest to the Veteran's home, calculated an estimate of the increase in demand (as measured by use) resulting from such availability, and rank-ordered market areas by the predicted demand increase. Results: Our results suggest that the largest potential increases in demand would occur in: (1) Boise, ID, (2) Salt Lake City, UT, (3) Fort Harrison, MT, (4) Gulfport, MS, and (5) Fort Meade, SD. These results are consistent with the observed high travel time burdens faced by Veterans generally in the western U.S., and suggest that lessening these burdens would produce relatively large changes in the number of disabled OEF/OIF Veterans using VHA services. Implications: When appropriate clinical infrastructure and institutional commitments are present, our results provide important and useful insights for improving access to VA rehabilitation services. Impacts: These results will enable VA planners to examine important "what-if" scenarios in their planning efforts. Because the methods used in this research have broad applicability across different services and populations, our work demonstrates how health services research can provide important input to VA strategic planning.

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