PDF(Pubmed)
Abstract：
OBJECTIVE: Post-9/11-era veterans with traumatic brain injury (TBI) have greater health-related complexity than veterans overall, and may require coordinated care from TBI specialists such as those within the Department of Veterans Affairs (VA) healthcare system. With passage of the Choice and MISSION Acts, more veterans are using VA-purchased care delivered by community providers who may lack TBI training. We explored prevalence and correlates of VA-purchased care use among post-9/11 veterans with TBI.
METHODS: Nationwide VA-purchased care from 2016 through 2019.
METHODS: Post-9/11-era veterans with clinician-confirmed TBI based on VA\'s Comprehensive TBI Evaluation (N = 65 144).
METHODS: This was a retrospective, observational study.
METHODS: Proportions of veterans who used VA-purchased care and both VA-purchased and VA-delivered outpatient care, overall and by study year. We employed multivariable logistic regression to assess associations between veterans\' sociodemographic, military history, and clinical characteristics and their likelihood of using VA-purchased care from 2016 through 2019.
RESULTS: Overall, 51% of veterans with TBI used VA-purchased care during the study period. Nearly all who used VA-purchased care (99%) also used VA-delivered outpatient care. Veterans\' sociodemographic, military, and clinical characteristics were associated with their likelihood of using VA-purchased care. Notably, in adjusted analyses, veterans with moderate/severe TBI (vs mild), those with higher health risk scores, and those diagnosed with posttraumatic stress disorder, depression, anxiety, substance use disorders, or pain-related conditions had increased odds of using VA-purchased care. Additionally, those flagged as high risk for suicide also had higher odds of VA-purchased care use.
CONCLUSIONS: Veterans with TBI with greater health-related complexity were more likely to use VA-purchased care than their less complex counterparts. The risks of potential care fragmentation across providers versus the benefits of increased access to care are unknown. Research is needed to examine health and functional outcomes among these veterans.
METHODS: Nationwide VA-purchased care from 2016 through 2019.
METHODS: Post-9/11-era veterans with clinician-confirmed TBI based on VA\'s Comprehensive TBI Evaluation (N = 65 144).
METHODS: This was a retrospective, observational study.
METHODS: Proportions of veterans who used VA-purchased care and both VA-purchased and VA-delivered outpatient care, overall and by study year. We employed multivariable logistic regression to assess associations between veterans\' sociodemographic, military history, and clinical characteristics and their likelihood of using VA-purchased care from 2016 through 2019.
RESULTS: Overall, 51% of veterans with TBI used VA-purchased care during the study period. Nearly all who used VA-purchased care (99%) also used VA-delivered outpatient care. Veterans\' sociodemographic, military, and clinical characteristics were associated with their likelihood of using VA-purchased care. Notably, in adjusted analyses, veterans with moderate/severe TBI (vs mild), those with higher health risk scores, and those diagnosed with posttraumatic stress disorder, depression, anxiety, substance use disorders, or pain-related conditions had increased odds of using VA-purchased care. Additionally, those flagged as high risk for suicide also had higher odds of VA-purchased care use.
CONCLUSIONS: Veterans with TBI with greater health-related complexity were more likely to use VA-purchased care than their less complex counterparts. The risks of potential care fragmentation across providers versus the benefits of increased access to care are unknown. Research is needed to examine health and functional outcomes among these veterans.
摘要：
目标：9/11后时代的创伤性脑损伤（TBI）退伍军人比整体退伍军人具有更大的健康相关复杂性，并且可能需要TBI专家的协调护理，例如退伍军人事务部（VA）医疗保健系统内的专家。随着《选择和任务法》的通过，更多的退伍军人正在使用由社区提供者提供的VA购买的护理，他们可能缺乏TBI培训。我们探讨了9/11后TBI退伍军人中VA购买护理使用的患病率和相关性。
方法：2016年至2019年全国VA购买的医疗服务。
方法：根据VA的综合TBI评估（N=65144），9/11时代后的退伍军人经临床医生确认的TBI。
方法：这是一个回顾性研究，观察性研究。
方法：使用VA购买的护理以及VA购买和VA提供的门诊护理的退伍军人比例，总体和按学习年份划分。我们采用多变量逻辑回归来评估退伍军人的社会人口统计学，军事史,以及从2016年到2019年使用VA购买的医疗服务的临床特征及其可能性。
结果：总体而言，在研究期间，有51％的TBI退伍军人使用了VA购买的护理。几乎所有使用VA购买的护理的人（99％）也使用VA提供的门诊护理。退伍军人社会人口统计，军事,和临床特征与他们使用VA购买的医疗服务的可能性相关。值得注意的是,在调整后的分析中，退伍军人中度/重度TBI（vs轻度），那些健康风险评分较高的人，那些被诊断为创伤后应激障碍的人，抑郁症,焦虑,物质使用障碍，或疼痛相关疾病使用VA购买的护理的几率增加.此外,那些被标记为自杀高风险的患者使用VA购买的护理的几率也更高.
结论：与健康相关的复杂性更大的TBI的退伍军人比那些不太复杂的人更有可能使用VA购买的护理。提供者之间潜在护理分散的风险与增加获得护理的好处是未知的。需要研究来检查这些退伍军人的健康和功能结果。
方法：2016年至2019年全国VA购买的医疗服务。
方法：根据VA的综合TBI评估（N=65144），9/11时代后的退伍军人经临床医生确认的TBI。
方法：这是一个回顾性研究，观察性研究。
方法：使用VA购买的护理以及VA购买和VA提供的门诊护理的退伍军人比例，总体和按学习年份划分。我们采用多变量逻辑回归来评估退伍军人的社会人口统计学，军事史,以及从2016年到2019年使用VA购买的医疗服务的临床特征及其可能性。
结果：总体而言，在研究期间，有51％的TBI退伍军人使用了VA购买的护理。几乎所有使用VA购买的护理的人（99％）也使用VA提供的门诊护理。退伍军人社会人口统计，军事,和临床特征与他们使用VA购买的医疗服务的可能性相关。值得注意的是,在调整后的分析中，退伍军人中度/重度TBI（vs轻度），那些健康风险评分较高的人，那些被诊断为创伤后应激障碍的人，抑郁症,焦虑,物质使用障碍，或疼痛相关疾病使用VA购买的护理的几率增加.此外,那些被标记为自杀高风险的患者使用VA购买的护理的几率也更高.
结论：与健康相关的复杂性更大的TBI的退伍军人比那些不太复杂的人更有可能使用VA购买的护理。提供者之间潜在护理分散的风险与增加获得护理的好处是未知的。需要研究来检查这些退伍军人的健康和功能结果。
