title: Evaluation of the Veterans Health Administration traumatic brain injury screening program in the upper Midwest.
abstract: OBJECTIVE
  To evaluate the Veterans Health Administration's traumatic brain injury (TBI) screening program in terms of predictors of screening and positive-screen follow-up.
  
  
  METHODS
  Retrospective administrative data study. Multiple logistic regression analyses were used to estimate the odds of TBI screening at a given appointment and among those screening positive, follow-up in a TBI/polytrauma specialty clinic.
  
  
  METHODS
  A total of 15,973 Iraq and Afghanistan war veterans treated at a Veterans Affairs medical center in the upper Midwest during the first 18 months of the TBI screening program.
  
  
  RESULTS
  Almost 90% of Iraq and Afghanistan veteran patients were offered TBI screening and 17% screened positive. Screening rates increased over time and varied by facility. Appointment type predicted screening with increased likelihood of screening during primary care and TBI/polytrauma clinic appointments. Younger, male, and army veterans without psychiatric diagnoses were more likely to be screened. Fifty-two percent of positive TBI screens had subsequent appointments in a TBI/polytrauma specialty clinic during the study period. Rates of follow-up in the clinic increased over time and varied by facility and patient characteristics.
  
  
  CONCLUSIONS
  Within the upper Midwest, Veterans Health Administration has had greater success implementing TBI screening than ensuring follow-up of positive screens in a specialty clinic. Research is needed on barriers to follow-up of positive screens and the outcomes of TBI screening and subsequent specialty care.
authors.affiliation: Center for Chronic Diseases Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA. nina.sayer@va.gov
authors.forename: Nina A
authors.initials: NA
authors.lastname: Sayer
authors.forename: Dave
authors.initials: D
authors.lastname: Nelson
authors.forename: Sean
authors.initials: S
authors.lastname: Nugent
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001930:Brain Injuries / Q000175:diagnosis*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D015146:Midwestern United States; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans