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Health Services Research & Development

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HSR&D In Progress

June 2022

In This Issue: HSR&D Research on Community Care
» Table of Contents


Community Care Use among Post-9/11 Veterans with Traumatic Brain Injury

Feature Article


Takeaway:This study is the first, to our knowledge, to measure patient-reported health and functional outcomes among Veterans with TBI who receive community care. Results will inform strategies to ensure continued delivery of coordinated high-quality care across the entire system in which Veterans with TBI are receiving care.


An estimated 20% or more of Veterans who served after 9/11 have had at least one military-related traumatic brain injury (TBI). In addition, Veterans with TBI are often co-diagnosed with neurological, mental health (i.e., PTSD, suicidal ideation), and pain disorders that interfere with daily functioning. VA’s Polytrauma/TBI System of Care (PSC) is an interdisciplinary program designed to meet the needs of Veterans with TBI and maximize their health and functioning using evidence-based practices. Since the passage of the Veterans Choice (2014) and MISSION Acts (2018), which allow increased access to healthcare outside VA, many Veterans with TBI also receive services through VA’s Community Care Network (CCN). However, dual use of services can lead to fragmented care, which may be particularly detrimental to Veterans with complex healthcare needs. Preliminary work suggests that higher proportions of Veterans with TBI diagnoses, relative to those without TBI, are receiving VA community care services, which may lead to the receipt of therapies that are not recommended for these often complex patients.

VA’s Community Care Network (CCN) is VA’s direct link with community providers and is comprised of five regional networks across the U.S.

This ongoing study (June 2021 – December 2024) will describe the use of community care (e.g., rates and types of, and reliance on) among post-9/11 Veterans with TBI. Investigators also will estimate the associations between their reliance on community care and health and functioning, in addition to examining their experiences and satisfaction with community care.

Methods

This mixed-methods project will link data identifying post-9/11 Veterans with TBI to administrative data, identifying VA healthcare use including community care. Investigators will use VA and Department of Defense (DoD) data to examine patterns of community care use over time, as well as by Veterans’ sociodemographics, military history, TBI severity, medical complexity, and history of PSC use. They also will survey a random sample of 1,800 Veterans with TBI to estimate associations between their reliance on community care and their health and functional outcomes, while accounting for potential confounders and sources of bias. In addition, they will interview 100 Veterans to examine factors related to their access to, satisfaction with, trust of, and actual and perceived quality of community care.

Findings

Between 2016 and 2019, nearly half (49%) of Veterans with TBI used VA community care services; the number who used community care increased considerably from year to year. Those who used community care were more likely to be women Veterans than those who did not, and were more likely to have Medicaid insurance, to live rurally, and to live farther from VA primary care. Results to date also suggest that Veterans with more severe TBI and more complex comorbidity profiles (e.g., diagnosed pain, depression, PTSD, substance use disorder, and anxiety) were more likely to receive community care services than those with mild TBI and those without these comorbidities. Additionally, Veterans with flags in their VA electronic health record for high suicide risk were more likely than those without to have received community care services. Ongoing research will examine health and functioning among these Veterans and their satisfaction with community care services.

Anticipated Impact

This study is the first, to our knowledge, to measure patterns of use and patient-reported health and functional outcomes among Veterans with TBI who receive community care. Results will inform strategies to ensure continued delivery of coordinated high-quality care across the entire system in which Veterans with TBI are receiving care. This work also will help identify subgroups of Veterans whose healthcare needs are not being met and who are at risk of poor outcomes.

Principal Investigator: Kathleen Carlson, PhD, is a Core Investigator with HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC) in Portland, OR.

Publications

None to report at this time.

View study abstract

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