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BACKGROUND/RATIONALE:
TBI is an important concern among returning OIF/OEF veterans with prevalence estimates in the 10-28% range (Okie, NEJM, 2005). The VA is pilot testing a TBI clinical reminder screening protocol (Perlin, IL 10-2006-004) to ensure the identification and full evaluation of veterans at high risk of having TBI. Intrinsic to TBI, however, are symptoms that may present barriers to successful transition from screening to evaluation and treatment. These include attention, concentration, and memory deficits, impaired awareness of problems, and behavioral manifestations such as apathy, dependency, slowness and passivity (French, 2006). Further complicating TBI care are overlapping combat stress reactions that can include similar symptoms. These symptoms may disrupt the hand off from screening to comprehensive assessment and treatment compromising the effectiveness of the TBI clinical reminder.
OBJECTIVE(S):
The specific objectives of the proposed study are:
1. To synthesize patient perceptions of barriers and facilitators to full TBI assessments following a positive TBI screen using the VA clinical reminder.
2. To identify patient characteristics from chart review and patient report that are risk factors for failing to transition from positive TBI screen to full assessment.
3. To examine the association between gender and other patient factors that affect TBI screening in OIF/OEF veterans
METHODS:
Veterans will be identified by clinician investigators and asked to participate in the study. Participants will be reimbursed $30 for their participation. Participant consent and interviews will be audiorecorded either in person or by telephone. A single investigator will use scripted questions and ad hoc follow up questions to assess barriers, facilitators and other factors associated with receiving full TBI evaluation. Interviews will be transcribed, coded and analyzed using computer coding software. Chart review will be conducted to complete clinical and demographic information about participants. Data will be stored in a password protected database on the VA server accessible only by study investigators. Data will be analyzed to summarize barriers and facilitators and to test hypothesized associations between patient factors and completion of TBI evaluation.
FINDINGS/RESULTS:
None at present time.
IMPACT:
This study will improve implementation of the OIF/OEF Traumatic Brain Injury (TBI) Clinical Reminder by identifying barriers and facilitators to full evaluation among veterans who screen positive for TBI. Findings and recommendations will be summarized and disseminated through clinical and research meetings, newsletters and personnel training locally, through VISN 3 and nationally in conjunction with Polytrauma and Blast-related Injuries QUERI and WRIISC.
PUBLICATIONS:
None at this time.
DRA:
Military and Environmental Exposures
DRE:
Diagnosis and Prognosis, Treatment
Keywords:
Traumatic Brain Injury
MeSH Terms:
none
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