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BACKGROUND/RATIONALE:
Polytrauma/Blast-related injuries (PT/BRI) are the most frequent cause of combat-related trauma, and represent a high priority, high cost area for the VA. Immediate complications from blasts encountered in battle can be characterized as blunt trauma to the brain, head, spine, torso and extremities, complications of gas filled organs, burns, fractures, hearing and vision loss. To date there is no established model for providing blast injury medical care.
OBJECTIVE(S):
The immediate goal of this study is to more fully understand the range and patterns of clinical complications associated with blast injuries sustained in Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF), necessary to provide timely and appropriate care. The objectives for this one-year descriptive study are to:
1. Characterize the diagnoses, treatments, and clinical complications associated with initial VA hospitalization for persons with blast injuries, using data from FY03-06.
2. Investigate health care utilization and costs associated with VA inpatient and outpatient services for individuals with blast-related complications for the first 18 months after presenting to the VA medical center.
METHODS:
Quantitative and qualitative methods will be used to research objectives. For objectives 1 and 2, the sample will include all OIF/OEF veterans with blast related injuries presenting to the James A Haley VAMC at Tampa, Fl between 2003 and the early part of 2007. Chart reviews using the Veterans’ Health Information Systems & Technology Architecture (VistA) and data collection protocols developed at the PT/BRI Center at the Tampa VA will be used to address Objective 1. VA administrative data such as the Medical SAS Inpatient and Outpatient Datasets, and Decision Support System (DSS) will be used to capture healthcare utilization and costs (Objective 2).
FINDINGS/RESULTS:
We have gathered data on the treatment, costs, inpatient and outpatient rehabilitation healthcare use and associated health outcomes on more than 100 veterans of OIF/OEF wounded in combat from blast related injuries and referred to the Polytrauma Rehabilitation Center (PRC) at the Tampa VAMC from September 2003 to December 2006.
Findings: The average age of combat returnees was 26 (standard deviation: 7.8). The predominant diagnosis was Traumatic Brain Injury. Mean length of stay was 36 (26) days at an average cost of $ 48,500 ($34k). Total cost of rehabilitation interventions significantly (p<.01, R squared: .20) influenced change in Functional Independence Measure scores. Functional Status at discharge is a strong predictor of future haelthcare utilization in the VHA.
Our preliminary findings are contained in poster presentations at HSR&D's 25th and 26th National Meetings and in forthcoming articles in the VA Journal of Rehabilitation and Research Development (JRRD) and Rehabilitation Nursing.
IMPACT:
Information gained and associated research findings will be valuable to the 4 newly designated VHA Polytrauma Centers for determining taxonomy of PT/BRI. In this proposed study, we are pilot testing gap identification and diagnosis methods that we plan to make available to the other three PT/BRI clinical centers and the Polytrauma QUERI to promote evidence-based care.
PUBLICATIONS:
None at this time.
DRA:
Acute and Traumatic Injury, Military and Environmental Exposures
DRE:
Rehabilitation, Treatment
Keywords:
PTSD, Spinal cord injury, Operation Iraqi Freedom
MeSH Terms:
none
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