Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain.

As a large national healthcare system, Veterans Health Administration (VHA) is ideally suited to build on its work to date and develop a safe, evidence-based, and comprehensive approach to the care of chronic musculoskeletal pain conditions that de-emphasizes opioid use and emphasizes non-pharmacological strategies. The VHA Office of Health Services Research and Development (HSR&D) held a state-of-the-art (SOTA) conference titled "Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management" in November 2016. Goals of the conference were (1) to establish consensus on the current state of evidence regarding non-pharmacological approaches to chronic musculoskeletal pain to inform VHA policy in this area and (2) to begin to identify priorities for the future VHA research agenda.

Excess mortality associated with mental illness and substance use disorders among veteran clinic users with spinal cord injury.

Purpose: Among veterans with traumatic spinal cord injury (SCI) or disease aetiologies, examine the association between diagnosed mental illness (MI) and substance use disorders (SUD) on mortality after controlling for demographic and socioeconomic factors, SCI severity, injury duration and chronic physical illnesses.

Method: Longitudinal analysis of Veteran Health Administration(VHA) administrative data and Medicare claims for FY 1999-2004 matched with Spinal Cord Dysfunction-Registry (SCD-R) of VHA clinic users (N = 8334) with SCI. SCI was identified through SCD-R; individual MIs (anxiety, bipolar, depressive disorders, psychoses, post-traumatic disorder and schizophrenia) and SUDs (tobacco, alcohol and/or drug) were identified through ICD-9-CM codes.

Depression treatment patterns among women veterans with cardiovascular conditions or diabetes.

The study aimed to examine treatment patterns for depression among women veterans diagnosed with cardiovascular conditions or diabetes. We used longitudinal data from the 2002-2003 merged Veteran Health Administration (VHA) and Medicare files. Chi-square tests and multinomial logistic regression were performed to analyse depression treatment among veteran women with incident depressive episode and one of the following chronic conditions: diabetes or coronary artery disease or hypertension.

Organization of care and diagnosed depression among women veterans.

Objective: To analyze the association between the organizational features of integration of physical and mental healthcare in womens health clinics and the diagnosis of depression among women veterans with or at risk for cardiovascular conditions (ie, diabetes mellitus, heart disease, or hypertension).

Study Design: Retrospective and observational secondary data analyses.

Methods: We studied 27,972 women veterans from 118 facilities with diagnosed cardiovascular conditions in fiscal year 2001 (FY2001) using merged Medicare claims and Veterans Health Administration (VHA) data merged with the 1999 VHA Survey of Primary Care Practices and the 2001 VHA Survey of Women Veterans Health Programs and Practices.

Depressive disorders among cohorts of women veterans with diabetes, heart disease, and hypertension.

Objectives: To compare the rates of major and minor depression in cohorts of women veterans with diabetes or heart disease or hypertension and examine variations in these rates by demographic, socioeconomic, and health status among these women.

Methods: This was a retrospective cross-sectional analysis of fiscal year 2002 and 2003 data on 13,430 women veterans with diabetes or heart disease or hypertension who were diagnosed with depression and used Veteran Health Administration (VHA) clinics. International Classification of Diseases, 9th ed.

Mental illness and substance use disorders among women veterans with diabetes.

Objectives: We sought to estimate the prevalence of mental illness (MI) and substance use disorders (SUD) and determine the predictors of MI/SUD categories among veteran women with diabetes.

Methods: We evaluated a cross-sectional analysis of 16,368 women veterans with diabetes in fiscal 1999 and 2000. SUD, MI, and diabetes were identified using validated algorithms based on diagnosis codes.

Obesity and expenditures among elderly Veterans Health Administration users with diabetes.

A retrospective cross-sectional analysis of Veterans Health Administration (VHA) administrative and Medicare fee-for-service (FFS) claims data was used to evaluate the association between body mass index (BMI) categories and expenditures among elderly VHA users with diabetes. The study sample included respondents to the 1999 Large Health Survey of Veteran Enrollees who were diagnosed with diabetes in fiscal year 1999, age 65 or older, and enrolled in Medicare FFS (N = 79,934). Types of expenditures included inpatient, outpatient, and a summation of the 2 in the fiscal year 1999.

Disparities in preventive care by body mass index categories among women.

Objective: The present analyses examined the relationship of body mass index (BMI) categories to receiving age-appropriate preventive services among women.

Method: Data from the Medical Expenditure Panel Survey (2003, N = 10,954) were analyzed using multiple logistic regressions. Outcomes were: age-appropriate Pap-test, mammography, colorectal, cholesterol and blood pressure screening, and influenza immunization.

Risk of stroke, heart attack, and diabetes complications among veterans with spinal cord injury.

Objectives: To compare the rates of diabetes and macrovascular conditions in veterans with spinal cord injury (SCI) and to examine variations by patient-level demographic, socioeconomic, access, and health status factors.

Design: A retrospective analysis. Diabetes status was classified by merging with diabetes epidemiology cohort using a validated algorithm.

Expenditures in mental illness and substance use disorders among veteran clinic users with diabetes.

Few studies have looked at the health-care expenditures of diabetes patients based on the type of co-occurring conditions of mental illness (MI) or substance use disorders (SUD). Our study analyzes the health-care expenditures associated with various diagnostic clusters of co-occurring drug, alcohol, tobacco use, and mental illness in veterans with diabetes. We merged Veteran Health Administration and Medicare fee-for-service claims database (fiscal years 1999 and 2000) for analysis (N = 390,253) using generalized linear models; SUD/MI were identified using International Classification of Diseases, 9th edition codes.

Chronic illness with complexities: mental illness and substance use among Veteran clinic users with diabetes.

Objective: Create a taxonomy and examine the predictors of the often co-occurring conditions of substance use disorders and mental illness in veterans with diabetes.

Design: Merged Veteran Health Administration and Medicare fee-for-service claims data (N = 485,893).

Results: Thirty-one percent of patients with diabetes were diagnosed with either mental illness or substance use and had higher rates of diabetes-related complications.