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  • Veterans with Multiple Chronic Conditions Account for Disproportionate Share of VA Healthcare Costs
    This study examined the association between number of chronic conditions and costs of care for non-elderly (<65 years) and elderly Veterans (=65 years) within the VA healthcare system – and estimated VA expenditures for the most prevalent and costly combinations of three conditions (triads). Findings showed that Veterans with multiple chronic conditions account for a disproportionate share of VA healthcare costs. Almost one-third of non-elderly and slightly more than one-third of elderly VA patients had >3 conditions, but they accounted for 65% and 67% of total VA healthcare costs, respectively. The most common triad of chronic conditions for both non-elderly and elderly Veterans was diabetes, hyperlipidemia, and hypertension (24% and 29%, respectively). Conditions present in the most costly triads included: spinal cord injury, heart failure, renal failure, ischemic heart disease, peripheral vascular disease, stroke, and depression. While patients with the most costly triads had average costs that were three times higher than average costs of patients in other triads, the prevalence of these costly triads was extremely low (0.1 to 0.4%). These findings highlight the need for interventions that target the sickest patients who have high resource use to provide more cost-effective care.
    Date: March 1, 2014
  • Pain and PTSD Common Comorbidities among OEF/OIF Veterans with Spinal Cord Injury Undergoing Inpatient Rehabilitation
    Pain and PTSD were more likely to manifest as comorbidities than as isolated conditions during inpatient rehabilitation for spinal cord injury. Comorbid pain and PTSD symptoms were more common than either condition alone, and nearly as common as not having either condition. Veterans with pain at the beginning of rehabilitation showed declines in pain ratings over the course of rehabilitation. In contrast, Veterans in the “PTSD Alone” group showed increasing pain over the course of rehabilitation. Factors not associated with pain and PTSD status were: demographic and SCI characteristics, number of comorbid traumatic injuries, and the prevalence of individual comorbid injuries.
    Date: August 1, 2012
  • Veterans with Spinal Cord Injury and Pressure Ulcers have More Hospitalizations and Higher Costs of Care
    This study compared the annual healthcare utilization and costs of Veterans with spinal cord injury/disorder (SCI/D), with and without pressure ulcers, who used the VA healthcare system. Findings show that among Veterans with SCI/D, pressure ulcers were associated with greater rates of hospitalization and higher healthcare costs. After adjusting for patient demographics, comorbidities, and other characteristics, total annual healthcare costs per patient were $73,021 higher for Veterans with pressure ulcers and annual hospitalizations were nearly 52 days longer. This represents more than $89 million in total additional costs to the VA healthcare system. Higher total costs were due primarily to higher total inpatient costs for Veterans with pressure ulcers compared to Veterans without pressure ulcers. Factors associated with more total inpatient days included: older age, hospitalization within the 12-month period prior to the index date, and a history of depression.
    Date: April 15, 2011
  • Mental Illness and Substance Use Disorders Highly Prevalent Among Veterans with Spinal Cord Injury
    Using VA and Medicare data, this study sought to estimate the prevalence of mental illness and substance use disorders (SUDs) among 8,338 Veterans with spinal cord injury (SCI) who used outpatient or hospital care in VA or Medicare facilities between FY00 and FY01. Findings show that mental illness and SUDs are highly prevalent among Veterans with SCI. Overall, 47% of the Veterans in this study had either a mental illness or SUD. The most common mental illness was depression (27%), followed by anxiety (10%) and PTSD (6%). Tobacco use also was prevalent (19%), followed by alcohol (9%) and illicit drugs (8%). Moreover, mood and anxiety disorders were highly prevalent among those with chronic physical conditions such as diabetes, hypertension, and COPD. Results also showed that women Veterans had higher rates of mental illness and lower rates of SUD, and were significantly more likely to have mental illness only. In addition, as the duration of SCI increased, the likelihood of mental illness or SUD alone or in combination decreased.
    Date: November 1, 2009
  • Special Issue of Pain Medicine Highlights VA Research on Pain among OEF/OIF Veterans
    This publication is in follow-up to a Pain Research Summit held in September 2007 by VA’s Rehabilitation R&D Service and VA/HSR&D’s Polytrauma and Blast-Related Injury Quality Enhancement Research Initiative (PT/BRI-QUERI). This Special Issue begins with four articles that build on the growing epidemiological literature on the prevalence and correlates of pain among OEF/OIF Veterans, and considers the evidence for the assessment and management of pain in this population. The Issue also includes several original articles that provide a sample of the relatively large and growing body of research on pain, including research that focuses on the most prevalent and challenging of pain conditions observed among OEF/OIF Veterans, such as neuropathic pain, chronic widespread pain, musculoskeletal/joint pain, and pain secondary to spinal cord injury.
    Date: October 1, 2009
  • Bloodstream Infections in Veterans with Spinal Cord Injury May Require Different Treatment Strategies
    Bloodstream infections (BSIs) are a common type of infection in people with spinal cord injury. Bloodstream infections that occur in healthcare settings (e.g., acute care, long-term care) have been traditionally classified as community-acquired, but recent evidence suggests that these infections are distinct and may have a unique epidemiology. This retrospective review assessed characteristics associated with bloodstream infections that were: hospital-acquired (HA BSI), from healthcare contact outside the hospital (HCA BSI), or were community-acquired (CA BSI). Results show that HCA bloodstream infections accounted for 25% of all BSIs in hospitalized Veterans with spinal cord injury. Antibiotic resistance was more common in Veterans with HA BSI (65.5%) compared to those with HCA (49.1%) and CA BSI (22.2%). Methicillin-resistance in Staphylococcus aureus (MRSA) was highly prevalent: 84.5% in Veterans with HA BSI, 60.6% in Veterans with HCA BSI, and 33.3% in Veterans with CA BSI. Because several differences in medical characteristics and causal micro-organisms were found, the authors suggest that treatment and management strategies for HCA and CA infections may need to vary.
    Date: August 1, 2009
  • Improving Wheelchair Appropriateness for Adults with Spinal Cord Injury
    This study integrated and expanded upon previously published models of wheelchair service delivery to provide a preliminary framework for developing more comprehensive, descriptive models for adults with spinal cord injury (SCI). In this article, ‘wheelchair service delivery’ includes the process of justifying wheelchair selection, approving the selected wheelchair, delivering it to the client, fitting and customizing the wheelchair, and providing follow-up care and consultation. Findings show that most experts stress the importance of having both patients and providers play a key role in the process. For example, the primary patient factors identified were: wheelchair funding source, ability to pay out of pocket, decision-making capacity, self-awareness of needs, familiarity with products, and family influences. Suppliers also play an integral role and may significantly influence the appropriateness of the wheelchair provided. In addition, the authors identified a number of system-level factors (e.g., facility standards, policies, and regulations) that influence wheelchair service delivery.
    Date: June 1, 2009
  • Spinal Cord Injury and Alcohol Use are Risk Factors for Osteoporosis Hospitalization
    Spinal cord injury (SCI) is associated with severe osteoporosis, increasing the risk of low-impact fractures that occur in the absence of trauma. Findings from this study show that hospitalization for low-impact fractures was more common in motor complete SCI (no motor function below the neurological level of injury) and was associated with greater alcohol use after injury. Osteoporosis diagnosis, prevention, and management were not included in the treatment plans for any of the Veterans hospitalized with fractures. These findings suggest that future studies should address prevention and treatment of bone loss among Veterans with motor complete SCI.
    Date: March 1, 2009
  • OEF/OIF Veterans with Spinal Cord Injury and Additional Problems Require Timely Intervention to Avoid Rehabilitation Delays
    Soldiers returning from Iraq and Afghanistan with spinal cord injury often have additional medical and psychosocial problems that require timely intervention to avoid significant delays in rehabilitation. Rehabilitation was often delayed because other problems needed to be addressed first.
    Date: March 1, 2009
  • Barriers to Bone Density Testing for Patients with Spinal Cord Injury
    Several barriers to routine bone mineral density assessment among the SCI population were identified, e.g., scanner design that limits accessibility, and increased scanning time that requires additional staff. To help lessen these barriers, investigators recommend several changes, such as: installing ceiling-mounted hydraulic lifts and grab bars to facilitate transfers in the screening room, increasing staff during scans, and partnering with administrators and staff to raise awareness of access issues faced by individuals with spinal cord injury.
    Date: January 1, 2009
  • Pain among Veterans with Spinal Cord Injury
    Veterans reported higher rates of pain-related catastrophizing (exaggerated negative interpretations of pain, e.g., “my pain is unbearable and will never get better”). Authors suggest that in clinical settings it may be important to assess and manage catastrophizing as a factor important to the experience of pain and especially the impact of pain on functioning.
    Date: October 1, 2008
  • Veterans with Spinal Cord Injury Report Frequent Physical and Mental Health Concerns
    Overall, veterans with spinal cord injury (SCI) were much more likely to experience frequent physically and mentally unhealthy days, and frequent days with depression than what has been reported for the general population. In addition, both chronic illnesses and smoking had a substantial effect on health-related quality of life for persons with SCI.
    Date: July 1, 2008

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