Justin R. St. Andre

Prevalence and Treatment of Headaches in Veterans With Mild Traumatic Brain Injury

(Headache 2011;51:1112‐1121)

Healthcare Utilization and Costs of Veterans Screened and Assessed for Traumatic Brain Injury

Approximately 15% of casualties in the Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]) conflicts received mild traumatic brain injury (TBI). To identify Veterans who may benefit from treatment, the Department of Veterans Affairs (VA) implemented a national clinical reminder in 2007 to screen for TBI. Veterans who screen positive are referred for a comprehensive TBI evaluation. We conducted a national retrospective study of OIF/OEF Veterans receiving care at VA facilities between 2007 and 2008. We examined the association of the TBI screen with healthcare costs over a 12 mo period following the initial evaluation. Of the Veterans, 164,438 met inclusion criteria: 31,627 screened positive, 118,545 screened negative, and 14,266 received no TBI screening. Total healthcare costs of Veterans who screened positive, screened negative, or had no TBI screening were

Audiological issues and hearing loss among Veterans with mild traumatic brain injury

9,610,

An evaluation of the Veterans Affairs traumatic brain injury screening process among Operation Enduring Freedom and/or Operation Iraqi Freedom Veterans

5,184, and

Prevalence of Chronic Kidney Disease in Patients with Spinal Cord Injuries/Disorders

3,399, respectively (p < 0.001). Understanding these healthcare utilization and cost patterns will assist policymakers to address the ongoing and future healthcare needs of these returning Veterans.

Medication acquisition across systems of care and patient–provider communication among older veterans

We examined the prevalence, severity, etiology, and treatment of audiology problems among Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans with mild traumatic brain injury (TBI). A retrospective chart review was performed of 250 Veterans with mild TBI. Results of a comprehensive second-level mild TBI evaluation and subsequent visits to audiology were evaluated. We found the vast majority (87%) of Veterans reported some level of hearing disturbance and those involved in blast injuries reported a higher incidence of hearing disturbance than those with other injury etiologies. Audiology referrals were given to 75 Veterans and 37 attended. At this visit, Veterans reported tinnitus (75.7%) and hearing loss (59.8%). Nearly half (48.6%) of Veterans were diagnosed with conductive hearing loss, sensorineural hearing loss, or central auditory dysfunction. An additional 24.3% of Veterans had subclinical levels of auditory dysfunction. Our study has highlighted the increased prevalence of hearing loss among OIF/OEF Veterans and, thus, the need for appropriate referrals and treatment. Strategies to address perceived stigma associated with hearing loss may increase attendance at follow-up visits. Additionally, while only a third of audiograms were found to be abnormal, advanced testing resulted in a significant percentage of our population being diagnosed with auditory dysfunction.

Diagnostic Accuracy Studies in Mild Traumatic Brain Injury: A Systematic Review and Descriptive Analysis of Published Evidence

To describe the early results of the U.S. Department of Veterans Affairs (VA) screening program for traumatic brain injury (TBI) and to identify patient and facility characteristics associated with receiving a TBI screen and results of the screening.

Poster 23 Comparison of Symptom Presentation Between Veterans with Blast-Related Versus Non-blast-Related Mild Traumatic Brain Injury (mTBI)

Background and Objectives: Chronic kidney disease (CKD) and spinal cord injury and disorders (SCI/D) are common and costly conditions among Veterans. However, little is known about CKD among adults with SCI/D. Methods: We conducted cross-sectional analyses of Veterans with SCI/D across all VA facilities in 2006. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 and categorized by standard eGFR strata. eGFR was calculated in two ways: (a) the Modification of Diet in Renal Disease (MDRD) equation and (b) the MDRD equation + an empirically derived correction factor for SCI/D (MDRD-SCI/D). Logistic regression models were used to examine the relationship between patient characteristics and CKD. Results: Among 9,333 SCI/D Veterans with an available eGFR, the proportion with CKD was substantially higher based on the MDRD-SCI/D equation (35.2%) than based on the MDRD equation (10.2%). In adjusted analyses, while older age (OR for >65 years = 2.53; 95% CI: 2.21–2.89), female sex (OR 2.18; 95% CI: 1.62–2.92), and a non-traumatic cause for injury (OR 1.39; 95% CI: 1.23–1.57) were associated with an increased odds of CKD, black race (OR 0.64; 95% CI: 0.56–0.72) and a duration of injury of ≥10 years (OR 0.76; 95% CI: 0.67–0.86) were associated with a decreased odds of CKD. Diagnostic codes for CKD and nephrology visits were infrequent for SCI/D Veterans with CKD (27.51 and 6.58%, respectively). Conclusion: Using a recently validated version of the MDRD equation with a correction factor for SCI/D, over 1 in 3 Veterans with SCI/D had CKD, which is more than 3-fold higher than when traditional MDRD estimation is used.

Cost of Treating Pressure Ulcers for Veterans with Spinal Cord Injury

PURPOSE The results of a survey assessing Medicare Part D enrollment, the use of pharmacotherapies for chronic diseases, and other medication-use issues in a population of elderly military veterans are presented. METHODS Medicare-eligible (i.e., ≥65 years of age) patients with documented recent service use at a single Veterans Affairs (VA) medical center were targeted for a mail survey. Women were oversampled (20%) to ensure an adequate sample size; the sample was weighted to adjust for this oversampling. Usable survey data were received from 458 survey respondents. RESULTS Nearly all respondents (93.2%) reported having one or more chronic conditions; of those, 93.3% reported regular use of multiple drug therapies, and 30.1% reported using medications prescribed by both VA and non-VA providers for the same chronic condition. About half of the survey respondents reported at least one office visit with a non-VA physician during the previous year, and 55.8% reported obtaining medications from non-VA pharmacies. More than half (54.1%) of the respondents reported non-VA medication coverage, with 21.2% indicating they were enrolled in Medicare Part D. Among the respondents who reported obtaining medications from non-VA pharmacies, substantial proportions reported discussing those medications with VA physicians never (38.4%) or infrequently (15.7%). CONCLUSION Although large proportions of Medicare-eligible veterans take multiple medications and use non-VA health care services and pharmacies, many do not discuss medications obtained outside the VA system with VA physicians, suggesting that increased efforts to enhance provider-patient communication and medication reconciliation across VA and non-VA systems of care may be warranted.

A Comparison of Costs and Health Care Utilization for Veterans with Traumatic and Nontraumatic Spinal Cord Injury

To synthesize evidence and report findings from a systematic search and descriptive analysis of peer‐reviewed published evidence of the accuracy of tests used for diagnosing mild traumatic brain injury (mTBI). The article also summarizes points of concurrence and divergence regarding case definitions of mTBI identified during the review.