The Veterans Health Administration TBI/Polytrauma Program

Transcription

1 The Veterans Health Administration TBI/Polytrauma Program Joel Scholten, MD Special Projects Director, Physical Medicine and Rehab Program Office September 10, 2012

2 Physical Medicine & Rehabilitation National Director: David Cifu, MD Interdisciplinary team treatment process (Physiatry, Physical Therapy, Occupational Therapy, Kinesiotherapy) Designed to increase independence and improve quality of life for persons with disabilities Emerging Consciousness Amputation System of Care Stroke Rehabilitation Traumatic Brain Injury Driver Training Polytrauma System of Care Specialty Programs Specialty Care Management 2

3 PM&R Polytrauma / Traumatic Brain Injury (TBI) System of Care Integrated System of Care: Over 100 specialized rehabilitation sites 5 Polytrauma Rehabilitation Centers 23 Polytrauma Network Sites 86 Polytrauma Support Clinic Teams 40 Polytrauma Points of Contact Interdisciplinary care coordination and case management Advanced rehabilitation practices and equipment with focus on independence and community reintegration Provide life-long care and access to a continuum of services [For more information visit 3

4 PM&R Polytrauma / Traumatic Brain Injury (TBI) System of Care Regional Polytrauma Rehabilitation Centers for acute, comprehensive rehabilitation delivered by an interdisciplinary team of providers 2,315 total patients with severe injuries treated at VA PRCs (Mar 2003 Mar 2012) 1,346 Servicemembers (1006 injured in theater of operations) 969 Veterans Current occupancy rate averages 79% across PRCs (range: 40%-93%, varies over time and location) Current average length of stay in PRC is 46 days (range: days) Over 80% of patients are discharged to community (67% to home) Patient outcomes generally equal or exceed those of private sector facilities (functional improvement, discharge rate) 4

5 PM&R Polytrauma / Traumatic Brain Injury (TBI) System of Care Mandatory screening for traumatic brain injury (TBI) of OEF/OIF/OND Veterans on first visit Follow-up comprehensive evaluation for those with positive responses to TBI screening questions TBI Screening and evaluation 623,327 have been screened for possible mild TBI from since April ,734 screened positive and consented to follow-up 87,741 have completed comprehensive evaluation 48,881 received confirmed diagnosis of mild TBI (7.8% of total screened) 5

6 VHA Polytrauma/TBI System of Care FY2012 6

7 Emerging Consciousness Program 2-4 beds at each PRC Common assessment and management protocols Linked with academic centers who are leaders in DOC Embedded Epilepsy Centers of Excellence 7

8 Emerging Consciousness Program Outcomes Outcomes of the VHA Emerging Consciousness 122 patients Consecutive admissions at the 4 PRCs Main outcome - emergence to consciousness based on: CRS-R Object Use (feeding) Communication (responding to commands) Rancho 3 or higher Emergence from coma in 70% blast TBI, 85% non-blast TBI and 60% anoxic BI. Of those who emerge, 75% do so by 4 months post-insult. 8

9 Transitional Rehabilitation Program Located at 4 Polytrauma Rehabilitation Centers Provides interdisciplinary rehabilitation for patients in a 10- bed home-like unit for individuals requiring additional rehabilitation before community re-integration Additional specialized treatment and program support is provided as necessary for individual: PTSD services Substance abuse Pain management Drivers Training Rehabilitation Vocational Rehabilitation 9

10 Assisted Living Pilot for Veterans with TBI (AL-TBI) Five year pilot to assess the effectiveness of providing assisted living (AL) services to Veterans with TBI. Implemented through contracts with private sector, CARF-accredited TBI residential living programs located close to Veterans homes, with VA case management. 82 Veterans in the pilot in 6 states Age range: years Combat eras: OEF/OIF/OND, Gulf War, Persian Gulf, Vietnam, post Vietnam 10

11 Integrated Comprehensive Rehabilitation Care 11

12 Demographics of New Veterans Operation Enduring Freedom / Operation Iraqi Freedom Veterans (since FY2002) Left Active Duty and eligible for VA health care 1,478,370 Former Active Duty 821,318 (56%) Reserve and National Guard 657,052 (44%) Total separated and have obtained VA health care 804,704 ( 54%) have obtained VA health care (cumulative total) 751,754 ( 93% of 804,704) seen only as outpatients 52,950 ( 7% of 804,704) hospitalized at least once in VA ( 6 million total Veterans received VA health care during FY 2010) [Source: VHA Office of Public Health and Environmental Hazards, June 2012] 12

13 Future Plans Projected future needs and demand for services 25% of all Veterans utilizing outpatient care in VHA are seen by a Rehabilitation Services discipline provider Aging Veterans increasingly require medical rehabilitation services Since FY 2002, new Operation Enduring Freedom/Operation Iraqi Freedom/ Operation New Dawn (OEF/OIF/OND) Veterans are: o Seeking VA services sooner, o Presenting to VA with wide range of conditions (i.e., diagnoses encompass more than 8,000 discrete ICD-9 diagnostic codes), and o Percentage with any type of diagnosis will tend to increase over time as they continue to enroll for VA health care and develop new health problems 13

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