Veterans' Preferences for Exchanging Information Using Veterans Affairs Health Information Technologies: Focus Group Results and Modeling Simulations.

Background: The Department of Veterans Affairs (VA) has multiple health information technology (HIT) resources for veterans to support their health care management. These include a patient portal, VetLink Kiosks, mobile apps, and telehealth services. The veteran patient population has a variety of needs and preferences that can inform current VA HIT redesign efforts to meet consumer needs.

Health services and rehabilitation for active duty service members and veterans with mild TBI.

Objective: We review health services and reintegration practices that contribute to the rehabilitation of US active duty service members (ADSMs) and Veterans who experienced traumatic brain injury (TBI), especially mild TBI (mTBI), as discussed at the 2015 Department of Veterans Affairs (VA) TBI State-of-the-Art (SOTA) Conference.

Methodology: We reviewed the state-of-the-art at the time of the previous 2008 TBI SOTA Conference, advances in the field since then, and future directions to address gaps in knowledge.

Main Results: We reviewed: (1) mTBI and its comorbid conditions documented in ADSMs and Veterans, and recognized the need for additional healthcare utilization, health cost and quality of care studies; (2) VA vocational rehabilitation programmes and the effectiveness of supported employment for helping those with workplace difficulties; (3) the application of technology to assist in TBI rehabilitation, including mobile device applications for self-management, videoconferencing with providers, and virtual reality to help with behavioural and cognitive challenges, and (4) Department of Defense (DoD)-VA partnerships on identification, evaluation and dissemination of TBI best practices.

Delivery of mental health treatment to combat veterans with psychiatric diagnoses and TBI histories.

Traumatic brain injury (TBI) and mental health (MH) disorders are prevalent in combat veterans returning from Afghanistan and/or Iraq (hereafter referred to as returning veterans). Accurate estimates of service utilization for veterans with and without TBI exposure (referred to as TBI history) are imperative in order to provide high quality healthcare to returning veterans. We examined associations between TBI history and MH service utilization in a subsample of returning veterans who were newly diagnosed with posttraumatic stress disorder (PTSD), depression, and/or anxiety in the 2010 fiscal year (N = 55,458).

Rooted in the Community: Assessing the Reintegration Effects of Agriculture on Rural Veterans.

Objective: To assess the effect of a veteran-oriented community agricultural initiative on transitioning rural veterans.

Design: Convergent mixed-method program evaluation.

Setting: Veteran-oriented farm-to-market community agricultural initiative.

FIM-Minimum Data Set Motor Item Bank: Short Forms Development and Precision Comparison in Veterans.

Objective: To improve the practical use of the short forms (SFs) developed from the item bank, we compared the measurement precision of the 4- and 8-item SFs generated from a motor item bank composed of the FIM and the Minimum Data Set (MDS).

Design: The FIM-MDS motor item bank allowed scores generated from different instruments to be co-calibrated. The 4- and 8-item SFs were developed based on Rasch analysis procedures.

Interest in using mobile technology to help self-manage alcohol use among persons living with the human immunodeficiency virus: A Florida Cohort cross-sectional study.

Background: Alcohol consumption at hazardous levels is more prevalent and associated with poor health outcomes among persons living with the human immunodeficiency virus (HIV; PLWH). Although PLWH are receptive to using technology to manage health issues, it is unknown whether a cell phone app to self-manage alcohol use would be acceptable among PLWH who drink. The objectives of this study were to determine factors associated with interest in an app to self-manage drinking and to identify differences in baseline mobile technology use among PLWH by drinking level.

Comparison of the VA and NIDILRR TBI Model System Cohorts.

Objective: Within the same time frame, compare the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and VA Traumatic Brain Injury Model System (TBIMS) data sets to inform future research and generalizability of findings across cohorts.

Setting: Inpatient comprehensive interdisciplinary rehabilitation facilities.

Participants: Civilians, Veterans, and active duty service members in the VA (n = 550) and NIDILRR civilian settings (n = 5270) who were enrolled in TBIMS between August 2009 and July 2015.

Traumatic Brain Injury Severity, Comorbidity, Social Support, Family Functioning, and Community Reintegration Among Veterans of the Afghanistan and Iraq Wars.

Objective: To examine the association between traumatic brain injury (TBI) severity; social, family, and community reintegration outcomes; and return to work status among post-9/11 veterans in Department of Veterans Affairs (VA) care.

Design: Retrospective observational cohort study.

Setting: Mail/online survey fielded to a national sample of veterans.

Employment Stability in Veterans and Service Members With Traumatic Brain Injury: A Veterans Administration Traumatic Brain Injury Model Systems Study.

Objective: To examine incidence and predictors of employment stability in veterans and military service members with traumatic brain injury (TBI) who return to work.

Design: Prospective observational cohort study.

Setting: Four rehabilitation centers.

Use of the DEKA Arm for amputees with brachial plexus injury: A case series.

Objective: Patients with upper limb amputation and brachial plexus injuries have high rates of prosthesis rejection. Study purpose is to describe experiences of subjects with transhumeral amputation and brachial plexus injury, who were fit with, and trained to use, a DEKA Arm.

Methods: This was a mixed-methods study utilizing qualitative (e.

The stroke caregiving trajectory in relation to caregiver depressive symptoms, burden, and intervention outcomes.

Background: Caregiver depression and burden have a detrimental effect on stroke survivors' rehabilitation and are contributors to stroke survivors' hospital readmission and institutionalization. The stroke caregiving trajectory is unique compared to other illnesses, and the effect of length of caregiving on stroke caregiver outcomes is poorly understood. Interventions can improve caregiver outcomes, but the optimal timing of these interventions is unclear.

Examination of traumatic brain injury exposure among veterans with spinal cord injury.

Objective: The authors investigated lifetime exposure to traumatic brain injury (TBI) among veterans with spinal cord injury (SCI) in order to describe outcome differences as a function of self-reported TBI history.

Design: Cross sectional study, veterans with SCI (N = 857) completed the Ohio State University TBI Identification interview method (OSU-TBI); Veterans RAND 36-Item Health Survey (VR-36); Quick Inventory for Depressive Symptomatology, Self-Report (QIDS-SR); Patient Health Questionnaire-9; Satisfaction with Life Scale; Craig Handicap Assessment and Reporting Technique (CHART; along with clinician-rated Functional Independence Measure (FIM) Total, Motor, and Cognitive scores.

Results: Probable TBI exposure was described by 77.

Does functional motor incomplete (AIS D) spinal cord injury confer unanticipated challenges?

Purpose/objective: Examine psychological challenges associated with Spinal Cord Injury (SCI) among a cohort of Veterans. Research Method/Design: Cross-sectional descriptive study. SCI Centers participating in a multisite evaluation of longitudinal employment, quality of life, and economic outcomes among a large cohort of veterans with SCI, the Predictive Outcome Model Over Time for Employment (PrOMOTE) project.

Barriers and facilitators associated with colonoscopy completion in individuals with multiple chronic conditions: a qualitative study.

Background: A recommendation to undergo a colonoscopy, an invasive procedure that requires commitment and motivation, planning (scheduling and finding a driver) and preparation (diet restriction and laxative consumption), may be uniquely challenging for individuals with multiple chronic conditions (MCCs). This qualitative study aimed to describe the barriers and facilitators to colonoscopy experienced by such patients.

Materials And Methods: Semistructured focus groups were conducted with male Veterans who were scheduled for outpatient colonoscopy and either failed to complete the procedure or completed the examination.

Linking existing instruments to develop a continuum of care measure: accuracy comparison using function-related group classification.

Purposes: To compare measurement accuracy of test forms with varied number of items (13, 8, and 4 items) generated from the self-care physical function item bank composed of Functional Independence Measure (FIM™) and the Minimum Data Set (MDS).

Methods: Retrospective data analysis of 2499 Veterans who completed both FIM and MDS within 6 days. We compared measurement accuracy between the converted FIM (FIMc) motor score generated from the MDS and the original FIM (FIMa) motor score (13 items) at: (a) individual-level using point differences, and (b) group-level using function-related group (FRG).

Unique Aspects of Traumatic Brain Injury in Military and Veteran Populations.

Traumatic brain injury (TBI), in particular mild TBI (mTBI), is a relatively common injury experienced by service members across both deployed and nondeployed environments. Although many of the principles and practices used by civilian health care providers for identifying and treating this injury apply to military settings, there are unique factors that impact mTBI-related care in service members and Veterans. This article reviews several of these factors, including the epidemiology of TBI in the military/Veteran population, the influence of military culture on this condition, and identification and treatment of mTBI in the war zone.

Development and validation of a remote home safety protocol.

Aim: Environmental assessments and subsequent modifications conducted by healthcare professionals can enhance home safety and promote independent living. However, travel time, expense and the availability of qualified professionals can limit the broad application of this intervention. Remote technology has the potential to increase access to home safety evaluations.

Increased utilization of prolonged exposure and cognitive processing therapy over time: A case example from a large Veterans Affairs posttraumatic stress disorder clinic.

Prior single-site and regional studies have documented difficulties in implementing prolonged exposure (PE) and cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) into practice in Veterans Affairs (VA) Medical Centers, estimating that between 6% and 13% of VA patients with PTSD receive PE or CPT (Lu, Plagge, Marsiglio, & Dobscha, 2016; Mott et al., 2014; Shiner et al., 2013).

Regional variation in post-stroke multidisciplinary rehabilitation care among veteran residents in community nursing homes.

Introduction: Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors' functional recovery and daily living activities. The US Department of Veterans Affairs (VA) places veterans needing post-acute institutional care in private community nursing homes (CNHs). These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs.

Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury.

Purpose: In a 5-year study, individual placement and support (IPS) significantly increased employment rate of United States Veterans with spinal cord injury (SCI), a historically underemployed population. In a follow-up study, data on barriers and facilitators to IPS implementation were identified.

Methods: Over 24 months of implementation, 82 key medical and vocational staff underwent semi-structured interviews (n = 130).

Exploring the post-deployment reintegration experiences of veterans with PTSD and their significant others.

Veterans with family support have better functional recovery and reintegration outcomes. However, families' ability to support the veteran with PTSD's rehabilitation and reintegration oftentimes is hindered by interpersonal challenges. We report findings of a qualitative study that examined OEF/OIF veterans with PTSD/TBI and their significant others' (SOs') perceptions of family functioning.

Enhancing health and independent living for veterans with disabilities by leveraging community-based resources.

The number of US veterans with disabilities has increased in recent years as service members have returned home with extensive injuries and veterans from previous wars acquire functional limitations as a consequence of aging with chronic diseases. Veterans with severe disabilities need assistance and support to maintain independence at home and to avoid institutionalization. The US Department of Veterans Affairs (VA) strives to network with community organizations to achieve the best possible outcomes for veterans.

Individual Placement and Support in Spinal Cord Injury: A Longitudinal Observational Study of Employment Outcomes.

Objective: To determine the effects of a 24-month program of Individual Placement and Support (IPS) supported employment (SE) on employment outcomes for veterans with spinal cord injury (SCI).

Design: Longitudinal, observational multisite study of a single-arm, nonrandomized cohort.

Setting: SCI centers in the Veterans Health Administration (n=7).